Coun e ac ing Bo de ing P ac ices: Non-S a e Heal hca e P o ision o
Mig an s wi h P eca ious Legal S a us in Be lin
Au ho s: So ia Lehmann & Elisa Mannes
A chap e om: Schmiz, A., & Lehmann, S. (Eds.) (2025). Geog aphies o he Eu opean
Bo de Regime. How bo de s shape he e e yday li es o e ugees and asylum-seeke s.
Be lin Geog aphical Pape s, 56. h ps://doi.o g/10.17169/ e ubium-48773
Ins i u e o Geog aphical Sciences
F eie Uni e si ä Be lin
2025
Con ac
F eie Uni e si ä Be lin
Depa men o Ea h Sciences
Wo king G oup 'Socie y, Space and Gende '
Mal ese s . 74-100
D-12249 Be lin
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DOI: hUps://doi.o g/10.5281/zenodo.17466367
Ci a ion sugges ion: Lehmann, S., & Mannes, E. (2025). Coun e ac ing Bo de ing P ac ices:
Non-S a e Heal hca e P o ision o Mig an s wi h P eca ious Legal S a us in Be lin. Be lin
Geog aphical Pape s, 56, 14–26. h ps://doi.o g/10.5281/zenodo.17466367
Published in: Schmiz, A., & Lehmann, S. (Eds.) (2025). Geog aphies o he Eu opean Bo de
Regime. How bo de s shape he e e yday li es o e ugees and asylum-seeke s. Be lin
Geog aphical Pape s, 56. h ps://doi.o g/10.17169/ e ubium-48773
14
So ia Lehmann & Elisa Mannes
Coun e ac ing Bo de ing P ac ices: Non-S a e Heal hca e P o ision o
Mig an s wi h P eca ious Legal S a us in Be lin
Abs ac :
This pape explo es how non-s a e ac o s in Be lin coun e ac exclusiona y heal hca e
p ac ices ha a e concep ualised as u ban bo de ing p ac ices o he Eu opean bo de egime.
Focusing on neighbou hood-based o ganisa ions o e ing heal hca e o mig an s wi h
p eca ious legal s a us, we examine how hese ac o s na iga e he ension be ween immedia e
se ice p o ision and he b oade goal o sys emic e o m. D awing on i e semi-s uc u ed
in e iews and a quali a i e con en analysis, we ocus on wo guiding hemes: he neolibe al
shi o ca e esponsibili ies away om he s a e, and he ideological eimagining o heal hca e
as a holis ic, inclusi e p ac ice. Ou indings highligh how hese o ganisa ions ope a e unde
signi ican inancial and s uc u al cons ain s while s i ing o emain poli ically c i ical and
inno a i e. Despi e limi ed unding and challenging wo king condi ions, s a egies such as
building ne wo ks, educing ba ie s in accessibili y and main aining anonymi y a e used o
expand he each and e ec i eness o hei se ices. Howe e , his dual ole – p o iding ca e
and pushing o change – e eals con adic ions ha place p essu e on o ganisa ions’ ideals
and ope a ional capaci y. We conclude ha while hese non-s a e e o s o e inspi ing
models o inclusi e heal hca e, sus ainable change will equi e poli ical ecogni ion, inancial
suppo , and s uc u al e o m a he s a e le el.
1 In oduc ion
The igh o heal h, and he app op ia e ca e and se ices needed o access and main ain a
heal hy li e, is one o he cen al human igh s as de ined by he Wo ld Heal h O ganisa ion
(WHO 2023). Acco dingly, he In e na ional Co enan on Economic, Social and Cul u al Righ s
in 1976 demanded ha access o his basic human igh mus be ensu ed and p o ec ed o
all people, including indi iduals on he mo e, mig an s wi h and wi hou ce ain documen s
and e ugees (UNHCR n.d.; In e na ional Co enan on Economic, Social and Cul u al Righ s
1976). Unde Ge man law, e ugees and asylum-seeke s do no ha e legal access o he
gene al heal hca e sys em bu a e ins ead a o ded limi ed medical se ices unde he Asylum
Seeke s Bene i s Ac (AsylbLG) (In eg a ionsbeau ag e n.d.). People no egis e ed wi hin he
asylum-seeking p ocess o hose who ha e no been g an ed e ugee s a us, whose li ing
s a us is i egula ised and illegalised (De Geno a 2012) as ‘undocumen ed’ o ‘illegal’ mig an s,
canno access e en hese limi ed se ices. This is en o ced p ima ily as social se ice o ices
esponsible o he nego ia ion o o ms o access o heal hca e in Ge many a e legally
obliga ed o epo people wi hou a esidence pe mi o local au ho i ies, in acco dance wi h
he epo ing obliga ion (Meldep lich ) laid ou by he Ge man Residence Ac (§ 87 Au en hG).
While medical pe sonnel, bound by pa ien con iden iali y, a e exemp om his epo ing
15
obliga ion, he legal si ua ion o he social wel a e sys em ails o ensu e he con iden iali y
and p o ec he p i acy and sa e y o mig an s wi h p eca ious legal s a us1 in accessing
heal hca e (S ingl/Wieland 2017, pp. 16-17). Such legal and bu eauc a ic hu dles a e
concep ualised as bo de ing p ac ices (ibid., 16), as na ion-s a e bounda ies and bo de s a e
es ablished and upheld h ough exclusiona y p ac ices ha ex end beyond he physical
na ion-s a e bo de o in e ac wi h u ban scales (Fause 2017). In he case o Ge many and
i s speci ic legal and social wel a e sys em egula ions, bu eauc a ic mechanisms such as he
epo ing obliga ion a e iden i ied as especially es ic i e p ac ices o bo de ing in
compa ison o o he Eu opean s a es (ibid.), g an ing access o his basic human igh o
ce ain g oups while e using and ma ginalising o he s. We iden i y a cen al p oblem in his
cu en absence o sa e, su icien and accessible heal hca e o all people in Ge many,
ega dless o insu ance o esidence s a us.
Shi ing om he scale o na ional and sup ana ional (EU) policies, we emphasise ha ci ies
and municipali ies can exe cise hei u ban capabili ies in implemen ing p ac ices o he
Eu opean bo de egime mo e es ic i ely o mo e inclusi ely on he local scale
(K eichau /Maye 2021). In he ci y-s a e o Be lin, e o s o mo e agains such exclusiona y
bo de ing p ac ices by p o iding heal hca e o indi iduals wi hou heal h insu ance, as
pe aining o mig an s wi h p eca ious legal s a us, a e aken on by non-s a e o ganisa ions
(K eichau /Maye 2021; S ingl/Wieland 2017). This small-scale s uden esea ch p ojec
explo es he wo k o such non-s a e ac o s in coun e ac ing bo de ing p ac ices o he Ge man
heal hca e sys em. We unde s and such coun e ac ion bo h in physical o s uc u al e ms, as
p o iding di ec ca e o hose o whom access is o he wise denied, as well as in ideological
o poli ical e ms, as challenging hegemonial unde s andings o heal hca e sys ems and
na ion-s a e’s esponsibili ies o ca e. Seeking o unde s and how bo de ing p ac ices in he
ci y o Be lin, in he o m o unequal(ised)2 access o heal hca e, a e coun e ac ed in his
dualis ic sense, we ask he ollowing ques ions:
In wha ways does he shi ing o du ies o heal hca e away om s a es’ esponsibili y in
cu en neolibe al eali ies c ea e speci ic challenges o he wo k o non-s a e o ganisa ions
in he heal hca e sec o ? Wha s a egies a e employed by heal hca e o ganisa ions in
esponse o hese challenges?
1 We employ he e m ‘mig an s wi h p eca ious legal s a us’ he e o e e specifically o indi iduals wi h
expe iences o mobili y and mig a<on who do no possess legal s a us as e ugees o asylum-seeke s, and who
a e no in possession o a limi ed ole a<on (Duldung).
2 We use he ph asing o ‘unequal(ised)’ access he e o highligh he pu pose ul na u e o such inequali<es, so
as no o all in o he ap o ea<ng hese as objec< e o na u al. Th oughou ou p ojec , we seek o
con<nually emphasise he esponsibili<es and accoun abili<es o hegemonial sociopoli<cal and ideological
powe s uc u es and hei associa ed discou ses which delibe a ely pe pe ua e and seek o no malise s a es o
inequali y. We e e ence he e exis<ng analyses on he powe o language and discou se ha p oduce and
uphold hegemonial inequali<es (see also: Hall 1992)
16
Wha ole does a e-imagining o heal hca e and/o he in e oga ion o cu en hegemonial
unde s andings o heal hca e sys ems ha e o o ganisa ions p o iding heal hca e o mig an s
wi h p eca ious legal s a us?
We begin by in oducing ou b oade esea ch con ex and he heo e ical amewo ks ha
in o m ou s udy. Subsequen ly, we ou line ou me hodological app oach, accompanied by a
c i ical e lec ion on ou posi ionali y. This is ollowed by an o e iew o ou key indings,
which we hen si ua e and discuss in ela ion o exis ing bodies o esea ch and heo y. To
conclude, we summa ise ou main insigh s and o e a c i ical e lec ion on he limi a ions o
ou s udy, alongside sugges ions o u u e esea ch.
2 Heal hca e as a poli ical ield in bo de ing p ocesses
2.1 Loca ing he bo de : Heal hca e and (u ban) belonging
A g owing body o esea ch connec s bo de ing p ac ices and he nego ia ion o he Eu opean
bo de egime on u ban scales o exclusiona y and disc imina o y condi ions o unequal(ised)
access o heal hca e (Di S e ano 2024; Fause 2017; Johnson e al. 2011; Lebuhn 2013). Di
S e ano (2024) unde s ands heal hca e as a cen al mig a ion con ol ield while Fause (2017)
desc ibes he salien ole o heal hca e policies as a con ol mechanism o s a es used o
go e n mig a ion and mig an s. Resea ch on u ban bo de ing p ac ices in his con ex
emphasises how ci ies and municipali ies make use o hei ‘u ban capabili ies’ in eac ing
au onomously o local place-speci ic con ex s (K eichau /Maye 2021, 985). In so doing, ci ies
and municipali ies de e mine how he Eu opean bo de egime is pu in o p ac ice and
expe ienced locally. While some ci ies use hese capabili ies o implemen bo de egimes
mo e igo ously and exclusi ely, o he municipal go e nmen s ollow a mo e inclusi e p ac ice
by o e ing b oade se ices and access han na ional go e nmen s equi e (K eichau /Maye
2021; Kuge 2019). The wo k o non-s a e ac o s in esponse o o in con ac wi h such p ac ices
o u ban bo de ing is well- esea ched, especially wi hin he amewo k o sanc ua y o
solida i y ci ies ha aim o enac uniquely local o ms o inclusion and belonging (Fause 2017;
Özdemi /Pisa e skaya 2024). Baude (2016; 2017) and K eichau /Maye (2021), among
o he s, concep ualise such ac i is o al e na i e ac ion in es ablishing mo e inclusi e access
o heal hca e as a ‘ emaking’ o ‘ eimagining’ o ci ies and hei ole in heal hca e p o ision.
While we ind ample academic knowledge on u ban ci izenship and u ban belonging in his
con ex (Baude 2016; 2017; Ga cía Agus ín/Jø gensen 2021; K on/Lebuhn,2020), we iden i y
a gap in knowledge ocused mo e speci ically on ac o s and o ganisa ions wo king on he scale
o he neighbou hood wi hin he spa ial con ex o Be lin. Especially in Be lin, he scale o
neighbou hood, o ‘Kiez’ in Be lin e nacula , ep esen s a uniquely impo an ca ego y o
scale ha encompasses no only a speci ic e i o y, bu also a sense o belonging and
communi y (Hochmu h 2017). The e o e, we aim o ocus ou analy ical lens on o ganisa ions
in Be lin who a e ac i e especially on a neighbou hood scale, who iden i y wi h a speci ic
neighbou hood o who ha e a his o ical, logis ical, s a egic/poli ical o o he unique
connec ion o he neighbou hood in which hey a e spa ially loca ed.
17
Re u ning o ou dualis ic unde s anding o ‘coun e ac ing’ bo de ing p ac ices, which
acknowledges bo h a s uc u al and an ideological in e p e a ion o he e b, we o mula e
wo guiding concep s o o ganise he heo e ical amewo ks ha in o m ou esea ch p ocess
and ou analysis o esul s. The i s guiding concep ocuses on he s uc u al poli ics ha
con ex ualise he shi ing o heal hca e esponsibili ies o non-s a e o ganisa ions; ou second
guiding concep add esses impo an heo ies and knowledge ela ed o ideological and
discu si e unde pinnings ha in o m hegemonial de ini ions o heal hca e.
2.2 Guiding concep (1): Shi ing esponsibili ies in neolibe al eali ies
As al eady indica ed in chap e one, in many Ge man ci ies, including Be lin, ca e du ies o he
s a e in p o iding heal hca e o all people a e aken on by non-s a e o ci il socie y
o ganisa ions (K eichau /Maye , 2021, 987). This phenomenon can be eadily connec ed o
b oade known mechanisms o a neolibe al s a e and i s iew on heal hca e and wel a e
poli ics. Fo example, an Dyk/Miesbach (2016) explo e he e ec s o neolibe al policies on
olun ee wo k wi h e ugees, while Haubne and an Dyk (2023) desc ibe his shi o
heal hca e esponsibili ies o non-s a e ac o s as a ‘ci il-socie y-i ica ion’ o social ca e du ies,
highligh ing he salien ole o non-s a e ac o s’ wo k o ill in whe e s a es ake a s ep back in
his con ex . Known p oblems connec ed o his kind o ou sou cing om s a e o non-s a e
capaci ies include ha quali ica ions o se ice p o ide s may be lacking and ha se ices
canno be p o ided in he comp ehensi e, all-encompassing manne in which hey a e needed
(K eichau /Maye 2021, 989). Fu he mo e, non-s a e o ganisa ions illing in gaps in
heal hca e p o ision may esul in s a e go e nmen s no adjus ing hei policies and budge s
o mo e adequa ely ake on hese esponsibili ies (ibid.). We d aw on his c i ical pe spec i e
o accoun o he ac i e ole o he neolibe al s a e and i s capi alis endencies in
in es iga ing he shi ing o heal hca e esponsibili ies o non-s a e o ganisa ions. This is
e lec ed in ou i s esea ch ocus: In wha ways does his shi ing o du ies o ca e away om
s a es’ esponsibili y c ea e speci ic challenges o he wo k o non-s a e o ganisa ions? Wha
s a egies a e employed by o ganisa ions in esponse o hese challenges?
2.3 Guiding concep (2): Re hinking heal hca e
Connec ed o li e a u e on heal hca e p o ision and i s poli icised unc ion in cu en s a es
and socie ies is a key body o heo y on he concep o ca e i sel . Concep ualising ‘ca e’ in his
sense goes beyond p o iding medical se ices o unde s anding heal h and ca e also as
suppo ing o he necessi ies o human li e, such as social inclusion and communal ac i i y
(Sal iel 2021). Sal iel/S ü e (2022) build on Joan T on o’s ideas on c i ical eminis ca e e hics
in edi ec ing he ocus o unde s anding inequali ies in heal hca e se ings o unde lying
social s uc u es, linking ca e p o ision o b oade ques ions o social injus ices. Li e a u e on
ca e in his con ex demons a es how heal hca e and social se ices a e o e ed o made
accessible o some, as a p ac ice o ca ing, while being ac i ely denied o o he g oups in a
communi y o socie y, as ac i ely unca ing (Gabaue e al. 2021). Unca ing in p ac ice in e ac s
wi h legal and discu si e ca ego isa ions ha ma ginalise and exclude, as pe aining also o
hose ca ego ised and c iminalised as undocumen ed mig an (s) (Sal iel 2021). Such
18
di e en ial p ac ices o inclusion and se ice p o ision ha uphold un/ca ing mechanisms can
be concep ualised in e ms o ca e as an ac o inequali y (ibid.). This emphasises how ca e in
his con ex is a delibe a e ac ion, and he e o e nei he neu al no na u ally occu ing no
objec i e.
Imagina ions o dese ingness in heal hca e con ex s un pa allel o and in e ac wi h bina y
concep ualisa ions o iden i y/o he o belonging/no -belonging which a e inhe en in
upholding bo de egimes (Gabaue e al. 2021; Ko eweg/Yu dakul 2024; Sal iel 2021). This
is also iden i ied in Fo ou an’s (2019) pos mig an pe spec i e on cons uc ions o a ‘na i e-
mig an bina y’ as a discu si e mechanism o di e en ia ion in Ge man popula discou se.
These a gumen s sugges ha coun e ac ing bo de ing p ac ices in he o m o unequal(ised)
access o heal hca e equi es e hinking he sys emics o heal hca e p o ision i sel in wo
ways: i s , by in i ing o eimagine and e-de ine heal hca e as ca ing in i s b oade , mo e
holis ic sense, which includes a mul i ude o li e aspec s; and second, by di ec ing speci ic
ocus o he discu si e and ideological unde pinnings o ca e p o ision as an ac . Recalling ou
second esea ch ocus, we ask: Wha ole does a e-imagining o heal hca e and/o he
in e oga ion o cu en hegemonial unde s andings o heal hca e sys ems ha e o
o ganisa ions p o iding heal hca e o mig an s wi h p eca ious legal s a us?
3 Me hods and p ocess
This s uden esea ch p ojec d aws on quali a i e esea ch me hods, cen ing a ound i e
semi-s uc u ed in e iews conduc ed in Oc obe and No embe 2024. These in e iews we e
conduc ed wi h h ee o ganisa ions in Be lin who, acco ding o hei online p esence, p o ide
heal hca e se ices o indi iduals wi hou egula ised access o heal hca e in h ee
neighbou hoods, namely: open-med in S egli z-Zehlendo , open.med in Lich enbe g and
Gesundhei skollek i (Geko) in Neukölln. These con e sa ions wi h a p ojec assis an (I#1), a
p ojec manage (I#2), a p ac icing physician (I#3) and a doc o in u he aining (I#4) enabled
us o gain a b oade and mo e nuanced pe spec i e on ou esea ch opic. Fo he in e iews
a open.med in Lich enbe g and Geko in Neukölln, which we e conduc ed in pe son a hei
espec i e loca ions, addi ional expe ience logs (L#A; L#B) we e d a ed o documen ou own
obse a ions and imp essions o he spaces. Addi ionally, we in e iewed a esea che and
ac i is (I#5) amilia wi h ou esea ch ocus and wi h ex ensi e expe ise in his ield.
To c ea e meaning ul and ele an p omp s o ou semi-s uc u ed in e iews, we conduc ed
a p elimina y li e a u e e iew as well as basic esea ch on he o ganisa ions o ou
in e iewees. We adop ed a semi-s uc u ed app oach in he o m o an ‘in e iew guide’ as
opposed o he mo e s uc u ed ‘in e iew schedule’ (Dunn 2021, 151), wi h he aim o mo e
ully bene i om and espec ully acknowledge he expe ise o ou in e iew pa ne s.
In e iew opics ela ed o he wo k o he o ganisa ions in p o iding heal hca e se ices –
including hei goals, challenges hey encoun e and s a egies hey employ – as well as hei
isions o sugges ions o a mo e adequa e o inclusi e heal hca e sys em.
19
All in e iews we e analysed a e ansc ip ion using he compu e -based so wa e MAXQDA
and employing a quali a i e con en analysis acco ding o Kucka z (2018). Ou esea ch
me hod u ilised a deduc i e-induc i e app oach, beginning wi h deduc i ely de ined main
ca ego ies ha co esponded o he cen al hemes o ou in e iew guide as in o med by ou
esea ch ques ions. This was ollowed by se e al cycles o open induc i e and in- i o coding
o iden i y ele an subca ego ies, which ep esen impo an aspec s and key a gumen s
eme ging di ec ly om he da a collec ed. The s uc u e and con en o esul ing
subca ego ies and subcodes, as well as ela ions be ween hese, cons i u e ou empi ical
esea ch indings, which a e p esen ed in he ollowing chap e .
An essen ial aspec o ou conside a ions on esea ch e hics is ecognising and e lec ing on
ou own posi ionali y and p i ileges as well as po en ial powe imbalances inhe en in ou
esea ch se ing. We as s uden esea che s and au ho s o his pape possess bo h Ge man
ci izenship as well as gene al heal h insu ance, which ep esen s a o m o powe in spaces in
which ou esea ch was conduc ed. We aimed o emain con inuously awa e and c i ical o
ou own implici bias and subjec i i ies when o mula ing esea ch ques ions, en e ing he
spaces o he o ganisa ions we spoke wi h, in e ac ing wi h s a and use s o hese spaces
and h oughou ou coding p ocess and quali a i e analysis.
4 Findings
4.1 Na iga ing con ending objec i es
Ou indings highligh a challenge aced by heal hca e p o ide s who na iga e con ending
objec i es as hey es ablish on- he-g ound heal hca e s uc u es while simul aneously
ad oca ing o necessa y sys emic change in heal hca e p o ision o e all. As one in e iewee
no ed, o ganisa ions ‘a e aking on social wel a e esponsibili ies’ e en as his is iden i ied
clea ly as he s a e’s ‘du y as a wel a e s a e’ (I#5). Ano he in e iewee s a ed: ‘We [opened]
wi h he slogan, “ oo bad, bu we’ e opening” … because ac ually we’ e no supposed o exis ;
he esponsibili y is supposed o lie somewhe e else en i ely’ (I#1). This c i ical iewpoin on
he necessi y o aking on heal hca e p o ision despi e i being he esponsibili y o he s a e
was consis en ly exp essed h oughou all in e iews, indica ing he impo ance o his
dynamic o o ganisa ions and p o ide s o heal hca e in his con ex . In e iewees desc ibed
ha while aking on his acu e esponsibili y o ca e, hey emain a he same ime commi ed
o ad oca ing o sys emic change h ough poli ical wo k, ul ima ely aiming o ende
hemsel es obsole e (I#2; I#4). Na iga ing hese wo in en ions is desc ibed as no easy ask:
‘Tha you p o ide conc e e assis ance and a he same ime [o ganise] poli ical campaigns …
ha is eally exhaus ing’ (I#5). Con e sa ions wi h I#1 and I#4 desc ibe a unique app oach o
his dilemma which seeks o es ablish an al e na i e way o p o iding heal hca e cen ed
a ound se icing all esiden s in he o ganisa ions’ neighbou hood o Kiez, ega dless o
socioeconomic ac o s such as legal o insu ance s a us, o expe iences o mig a ion and
mobili y. Ins ead, his app oach emphasises a sense o belonging o a neighbou hood
communi y and sha ed li ing space, as opposed o a de ini ion o belonging oo ed in
26
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