On the quest for “medical home”: diasporic healthcare arrangements of Tunisians residing abroad

This thesis explores how transnational healthcare arrangements and diasporic networks shape the transnational healthcare strategies of Tunisian migrants. It unpacks the multiple strategies that migrants employ to navigate healthcare systems across borders, emphasising the interplay between formal and informal mechanisms, the impact of socio-economic disparities, and the importance of social networks and emotional ties.
Drawing on the literature on diasporic medical mobilities and a combination of sociological, geographical and anthropological work at the interplay of studies of health, migration and space, the thesis explores how diasporic ties are built and maintained through healthcare consumption. In doing so, this thesis examines the interactions between immigration, health and transnational medical mobilities in order to improve our understanding about how migrants’ presence in transnational social fields influences their healthcare practices.
The main research goal of this thesis is to explore how transnational healthcare strategies unfold and are refashioned through the variety of healthcare resources at the disposal of migrants, both in countries of residence and of emigration. More specifically, this study addresses the following research questions: what are the transnational strategies that migrants mobilise to meet their healthcare needs and expectations, and what does it say of their agency in the pursuit of healthcare?
The findings draw on a multi-sited ethnography in Tunisia, France and Belgium, which was carried out between 2019 and 2022 to investigate therapeutic mobilities taking place from, to, and between these different places. Research participants included Tunisian migrants (primarily first generation) and their families, Tunisian associations, public and private healthcare providers, and civil servants in the field of healthcare policies.
Moving across spaces, fields and disciplines, the thesis presents a comprehensive understanding of the relation between health, migration and transnational spaces, with the ambition that its multi-sited observations and conceptual proposals add to the emerging scholarship on the subject. In addition to examining the moral economy of healthcare and migration, this thesis proposes original concepts, such as the notion of “diasporic healthcare arrangements”, the transnational healthcare strategies “from below” and “from above” formulated within diasporic space; the notion of “diasporic therapeutic network” to qualify the therapeutic strategies deployed by and within the Tunisian diasporic network, using instances observed in the wake of the Covid-19 pandemic; and the concept of “medical home”, bridging literature on therapeutic landscape, diasporic medical travel and literature on the concept of home.
The general proposal of this thesis advances the argument that the quest for a “medical home” gives shape to a variety of transnational healthcare practices, mobilising diasporic therapeutic networks and resources, and shaping diasporic healthcare arrangements. The observation of such transnational healthcare practices invites us to rethink the limitations of a nation-state scale for provision and contribution to healthcare systems and social protection in general, and explore the all-encompassing relationships between health, migration and citizenship.