High on the excitement of a potential by-election victory this week, UKIP’s Nigel Farage has called for immigration restrictions on people with HIV. This proposal has been roundly criticised as prejudiced against people with HIV, as well as impractical (as argued by The Guardian‘s Sarah Boseley). But Farage’s suggestion taps into a longer history of the UK border control system being used to screen and reject incoming people who were viewed as ‘unhealthy’ or a threat to the health of the body politic. Below is a short excerpt from our new book, Race, Gender and the Body in British Immigration Control, that provides a bit of historical context for this, looking at how the border control system was used to prevent people from entering the country for ‘medical reasons’. People interested in this might also want to check out this 1983 article by Paul Gordon and this 2006 volume edited by Alison Bashford (who has written extensively about this subject in the Australian context).
The ways in which the physical body was to be examined within the British immigration system were codified in the various pieces of immigration control legislation and the internal instructions for immigration control staff and medical examiners circulated by the Home Office and the FCO. Officially, the primary purpose of the medical examinations to be conducted upon arriving migrants was to detect any health issues that might threaten the domestic population (and the migrant themselves); but this rationale was often used to disqualify ‘undesirable’ applicants and to extract further information from applicants (which could then be used to interrogate their claims if deemed unreliable).
The requirement that Commonwealth migrants be subjected to a medical examination was enshrined in the Commonwealth Immigrants Act 1962. The power to refuse entry on medical grounds after such an examination was outlined in the Act as follows:
2 (4) Nothing in subsection (3) of this section shall prevent an immigration officer from refusing admission into the United Kingdom in the case of any Commonwealth citizen to whom section one of this Act applies –
(a) if it appears to the immigration officer on the advice of a medical inspector or, if no such inspector is available, of any other duly qualified medical practitioner, that he [sic] is a person suffering from mental disorder, or that it is otherwise undesirable for medical reasons that he [sic] should be admitted.
However, the full parameters of the medical examination and its purpose in the immigration control system were only outlined in internal documents. Instructions given to Medical Inspectors in 1967 detailed six categories of Commonwealth migrants that could be referred to a Medical Inspector:
- holders of Ministry of Labour vouchers and their dependants (emphasis in the original text);
- other Commonwealth citizens intending to make their home in this country or to remain for more than six months…
- any immigrant appearing to … be mentally or physically abnormal or both;
- any immigrant appearing … not to be in good health;
- any immigrant appearing to be bodily dirty;
- any immigrant in regard to whom there is any mention of health as a reason for his visit.[i]
The medical examination posed a bureaucratic hurdle for most Commonwealth migrants entering during the 1960s, as they entered on work vouchers that depended on a clean bill of health; but the fact that dependent wives and children were also subjected to these examinations demonstrates the ‘desire for order’ of the immigration control system. The Home Office acknowledged that the ‘power to refuse on medical grounds does not apply to persons entitled to admission as wives … or children under 16’, but their referral to Medical Inspectors reinforced notions that migrants from the former colonies needed to be inspected to ascertain their physical ‘worthiness’ and that they needed to be screened as harbingers of disease. The FCO’s argument was that, although dependants could not be refused entry for medical reasons:
it is in their interests to be medically examined before leaving home, since if they require medical treatment, the medical report they bring with them will enable the British authorities to ensure that they receive such treatment as soon as possible after arriving in this country.[ii]
We would argue that it was in the interests of the British state to encourage those who did not technically require a medical examination to submit to one as this presented another administrative obstacle for the applicant, and could be used as an impetus for the authorities to find another official reason to deny them entry. FCO advice released in 1969 reiterated that dependants could be refused entry on medical grounds, but if an examination voluntarily submitted to ‘reveals that the dependant will need treatment in the United Kingdom’, the FCO stated that ‘a condition on admission may be imposed’.[iii]
The powers of Immigration Officers to refer migrants to a Medical Inspector and to refuse entry on medical grounds were made more explicit in the Immigration Act 1971. Schedule 2 of the Act simply stated:
(2) Any such person, if he [sic] is seeking to enter the United Kingdom, may be examined also by a medical inspector or by any qualified person carrying out a test or examination required by a medical inspector.
The Immigration Rules concerning medical examinations put forward that the ‘general aim’ of such examinations was ‘to enable [the] Immigration Officer to refuse entry to persons having a serious illness which might endanger the health of others’ or ‘persons suffering from a mental disorder or some serious condition which would prevent them from supporting themselves and their dependants’.[iv] However medical examinations were used to discredit the claims made by potential migrants and to intensify the scrutiny placed upon them. The scrutinising gaze of the immigration control system was thus cast upon the physical body as a marker of ‘truth’ when other forms of evidence (such as oral testimony and written documents offered by the applicants) were considered to be unsatisfactory.
Under the intense scrutiny of the border control authorities, if testimony and documents were not considered to be adequately convincing, the focus of the authorities shifted to physical examination, with the body becoming the marker of ‘truth’. As Didier Fassin and Estelle d’Hallunin wrote about refugees in the French border control system, ‘their word is systematically doubted [and] it is their bodies that are questioned’.[v] Unlike Foucault’s concept of torture, whereby the physical body is manipulated to extract the confession of ‘truth’ and the ‘truth’ is uttered or written by the tortured individual[vi], in the context under examination here the body becomes a text that is ‘read’ by the authorities, and the ‘truth’ is thus determined by those who ‘read’ it. In this process, the body reveals what the authorities want to see.
[i] ‘Instructions to Medical Inspectors’, n.d., FCO 50/132, National Archives, London.
[ii] ‘Medical Examination Overseas of Commonwealth Citizens Coming to the United Kingdom’, n.d., p. 2, FCO 50/132, NA.
[iii] ‘Advice to Medical Referees’, n.d., pp. 102, FCO 50/284, NA.
[iv] ‘Instructions to Medical Inspectors’, p. 1, RCRF/1/08, Runnymede trust archives, Black Cultural Archives, Lambeth.
[v] D. Fassin and E. d’Halluin, ‘The Truth from the Body: Medical Certificates as Ultimate Evidence for Asylum Seekers’, American Anthropologist, 107(4), 2005, p. 598.
[vi] See Michel Foucault, Discipline and Punish: The Birth of the Prison (London: Penguin Books, 1991) pp. 35-42; Michel Foucault, The History of Sexuality Vol. 1 (London: Penguin Books, 2008) pp. 58-61.