1The socio-anthropological literature on the COVID-19 pandemic has analysed its consequences in terms of social inequalities (Marabello and Parisi, 2020), migration regimes (Aumond et al., 2022), intergenerational tensions and the relationship between public and private in health and social care systems (Blumenthal et al., 2020). This broad perspective has made it possible to highlight the close links between the impact of illness, the power relations that determine it, and wider historical and social processes. This relationship has been particularly evident in studies of the health of migrants, who—with considerable variation in different national contexts—appear to be more exposed to social marginalisation, physical and mental vulnerability, and access to care than natives (Malmusi et al., 2010).

2Studies show that, except for a few categories such as asylum seekers and people from areas affected by famine, natural disasters or war, migrants’ health deteriorates rapidly during migration and the “healthy” migrant quickly becomes an “exhausted” migrant (Domnich et al., 2012). This is due to risk factors such as those associated with carrying out harmful jobs and job insecurity (Jordan, 2017), racist and discriminatory attitudes (Asad and Clair, 2018), socio-economic status (Quesada et al., 2011) and difficulty in accessing social and health services (Palència et al., 2013), all of which have an adverse effect on the health status of migrants. In particular, the degree of accessibility of health services is a key issue. This vulnerability, which affects migrant men and women differently according to gender, age, educational level and skin colour, represents one of the most important social determinants of their health in Italy as elsewhere (Carrasco Núñez, 2016).

3Since the mid-1990s, the analytical framework of Global Health has defined health as a set of determinants (social, economic, political, environmental), as well as the institutions involved in protecting and promoting well-being, strategies to combat exclusion, and the links between different phenomena (migration, food and labour insecurity, climate change) (Koplan et al., 2009). This perspective has directed socio-anthropological analysis towards the social, political and economic scenarios that determine the unequal distribution of illness and suffering at the local level and that condition individuals’ ability to make health choices (Nguyen and Peschard, 2003). This has led to a shift from socio-cultural contextualisation to the role that power relations between multiple actors play in the emergence and management of illness in specific contexts (Parker and Harper, 2006). In particular, through the concept of structural violence, medical anthropology has highlighted the link between illness, power and inequalities as manifested through pathogenic processes (Farmer, 2004). Illness is explored as the result of historically determined social and political forces that sanction differential exposure to disease risk (Fassin, 1996) and legitimise inequalities between individuals in accessing health resources and rights. This analytical perspective has shed light on the conditions that impose physical and emotional suffering—thus vulnerability—in a structured way on certain population groups through economic exploitation and exposure to risk factors in the living and working environment, and to cultural and gender discrimination (Quesada et al., 2011).

5In this paper we first examine the conditions that impose physical and emotional suffering on migrant women through economic exploitation and exposure to risk factors relating to the context in which they live and work. We explore the personal experiences of these women, together with migration-related difficulties to reveal how the pandemic doubly exposed female migrants to socio-economic challenges by hindering their access to care.

6Secondly, we attempt to investigate the relationship that subjects have with social structures of oppression and the ways in which these give life to their actions and the position in which they find themselves. Following women’s experiences, in this article we analyse instances of emancipation and agency that initiate the building of bonding and bridging networks and the use of social networks during illness. We consider the use of networks as strategies to cope with illness and therapy and to fill structural gaps in the care system. These resources appear to have been crucial during the pandemic, a time characterised by restricted mobility, social isolation and economic vulnerability, arising from an interruption of many of the work activities in which sick and non-sick migrant women were employed.

7The article is structured as follows. First, we outline the methodology, followed by a description of the research context. In the next three sections, we present the analysis of our results. We discuss the issue of migrant women’s access to health services by showing how the challenges they face depend on their legal and economic status. Then we consider the precarious nature of their employment and the impact of isolation during the pandemic, highlighting the importance of social networks in coping with cancer and its treatment. Finally, we show the supportive role played by digital networks and online forums as a means of disseminating health information but also as a tool for “making community”. In this sense, we interpret the use of digital networks as a way for female patients to organise and mobilise in defence of their health.

Research Setting and Methods

8This contribution is the result of research aimed at investigating access to the health system of migrant women living in Padua (Italy), focusing on oncological disease. The research methods consisted of in-depth interviews with twenty migrant women of different nationalities—mainly from Eastern European countries—and five Italian health professionals: medical doctors and psycho-oncologists working in associations and public health centres.

9Access to the field was facilitated by the Association Noi e il cancro-Volontà di Vivere (Cancer and Us-Will to Live—our translation), which organizes activities (including peer groups, meetings with psychologists) to support women who are living with cancer. Authors discussed the interview guide with the executive board of the Association to validate its contents and questions.

10Starting with some contacts provided by the Association, which initiated a snowball effect, we interviewed twenty women (one English, one Ukrainian, one Nicaraguan, one Croatian, two Romanian, two Moroccan, and twelve Moldovan) who were residents in Padua or in neighbouring municipalities. They were aged between thirty-three and sixty-seven (with an average age of fifty-five) and most worked as home caregivers (fifteen out of twenty). The others were employed as yoga teachers, a company sales manager, a factory worker and a restaurant cook, while one was unemployed. The common denominators were that they were migrants and had cancer or overcome an oncological disease. Breast cancer was the more common type of disease among our participants (fifteen out of twenty). This data reflects the fact that breast cancer is the most frequently diagnosed cancer in women in Italy, accounting for 41% of all female cancers under the age of fifty, 35% between the ages of fifty and sixty-nine, and 22% in women over seventy (AIOM et al., 2022). We developed a themes guide for the interviews that allowed us to understand the relational, social, and structural dimensions of their experience.

Access to Health Services and Migrant Women’s Legal and Economic Status

13In recent years, the issue of migrants’ health and the right to health has attracted the attention of international, governmental and non-governmental organisations and scientific research (WHO, 2013). Scholars have pointed out that, apart from asylum seekers who come from areas affected by famine, natural disasters or war, most migrants are healthy at the time of departure (“healthy migrant effect”) (Domnich et al., 2012). At the same time, they have shown how the health of migrants deteriorates rapidly during migration. The analysis of migrants’ health is intrinsically linked to that of the political-economic-social processes that determine the unequal distribution of disease and suffering. Using this approach, numerous studies have also focused on the analysis of migrants’ access to health services. This issue overlaps with the question of forms of citizenship and human rights because it questions the real possibility of people being able to make choices about health (Cerón and Jerome, 2019).

15This “diversity” of migrants’ experiences compared to natives also emerged in the testimonies of the migrant women we interviewed. They did not report discrimination or difficulty in accessing the public hospitals where they were treated. On the contrary, most testify to the good level of inclusiveness from the health services and their relationship with health professionals was sometimes described as almost “family-like”. In the health services, these women reported great consideration being given to their suffering by all members of the health hierarchy: nurses, doctors, social and health workers. However, migrant women’s relationships with the health services are conditioned by their occupational, economic and legal statuses and our interviewees confirmed they accessed the health services sporadically and only in cases of emergency. For this reason, the disease is often defined by informants as an unexpected event that manifests itself when the symptoms are already obvious. Most agreed they had neglected regular check-ups and delayed the first signs of discomfort (excessive tiredness, unjustified weight loss, small breast lumps). Neglect and fear of screening among the immigrant population are phenomena that remain little studied in Italy, while international literature has explained such resistance (Andreeva and Pokhrel, 2013). A lack of proficiency in the language, poor health literacy (Simonds, 1974) and different cultural health capital (Shim, 2010; Næss, 2019) are some of the factors that seem to contribute to limiting migrant women’s access to prevention programmes. The attention and self-care implied by prevention must also be considered in light of the external conditions of a subject deprived of a range of choice and action. This becomes particularly evident in the experiences of those who report that they only learned about the importance of screening in Italy after their disease was diagnosed. Carmen explained what she called a “deficient culture of prevention” by talking about the privatisation and spending cuts that have weakened the public health systems in her country:

“I had to learn about prevention as an adult in Italy. I had to change my culture of not going to the doctor, of avoiding, of denying sickness. Because in my country you do not go to the doctor unless you are really sick. In Nicaragua it is a struggle, the health culture is very weak, it is too expensive, you don’t know if you’ll be able to pay and so the defence mechanism of denial is triggered: deny, deny, deny until you can’t deny anymore.” (Interview with Carmen, 33, Nicaraguan, conducted online on 23 November 2020)

16In addition to the above, there are several logistical impediments, such as a lack of time and difficulty in reaching services during working hours. These are also relevant in getting Italian women to take part in preventative screening but in the case of migrant women they appear even more limiting. Irina, a woman employed in a cleaning company, explained:

“I had started to feel some pain in my breast, but I went on for about a year because I had to go to see my general doctor. His clinic is far from my house, and when I decided to go there, I had my period or I had to work… I didn’t go there very often. One evening I had very strong pain, but I went on for another week. Then when I saw that it didn’t go away, I went there and as soon as he examined me, he immediately told me: ‘You must urgently have a mammogram’. That’s when it all started.”(Interview with Irina, 44, Moldovan, conducted online on 13 July 2020)

17Our interviewees, like most migrant women, were employed in dirty, dangerous and difficult/demeaning jobs (so-called “3D” jobs) that do not give them good enough working conditions to enable the full realization of their right to health. The underestimation of health problems is common to the experiences of many female migrant workers as evidenced by the testimony of Nina, a in-home caregiver. Nina’s failure to take part in prevention programmes was linked to her workload and her role as breadwinner for her family in Moldova and her Italian-born son. Therefore, she said that the cancer “came suddenly”:

“I never had a mammogram, I never had time because I worked so much, day and night because I had a small child that I didn’t want to deprive of anything. And then the cancer came. One morning I woke up with my breasts all red and swollen. The first thing I did was call an Italian friend, and she said: ‘Call the doctor now!’ I called him, he saw me urgently and sent me straight away for a mammogram. […] That’s how I found out: overnight, after waking up with breast fever.”(Interview with Nina, 47, Moldovan, conducted online on 15 July 2020)

18As mentioned above, most of the women interviewed were concentrated in the home care work sector in Italy. Generally informal, this sector is characterised by strict work patterns and poorly regulated working hours, conditions that can compromise migrant women workers’ attention to their own health and use of available health services. In other words, living, working and legal status affect the immediacy of relations with health services, as in the emblematic case of irregular migrants who, not having their own general practitioner, resort to consulting the doctors used by the people they assist for an initial diagnosis. The overlap between the assisted person’s general practitioner and the assistant’s general practitioner, already highlighted in the literature (Tognetti Bordogna, 2009) allows migrant women to access health services, sometimes for the first time.

19The case of Petra shows that access to health services may be conditioned by the vicious intertwining of labour and economic condition and legal status. We consider her experience as a case in point because it shows how the problems experienced by sick migrant women were exacerbated by/during the pandemic when many lost their jobs, wages, accommodation and health insurance.

20Petra worked as a caregiver in a live-in care regime, which in Italy is informally defined as a “24-hour working regime”, when she was diagnosed as having cancer. The surgery and subsequent treatment she had to undergo caused her dismissal and a decline in her economic situation. Petra ended up becoming homeless. Having no employment, the consequential expiry of her health card and homelessness meant that it was impossible for her to continue to benefit from certain health services and to schedule subsequent check-ups. In addition, the lockdown made it impossible for her to collect reports of medical investigations carried out before her health card expired. In this regard, she told us:

“I left the hospital at 2 a.m. and at 3.30 a.m. the son of the elderly person I was caring for threw me out of the house. He said he needed a caregiver and not a sick person to care for. The law states that fifteen days’ notice is required in these situations. I could have called the police, but I didn’t want to make the old man suffer and I left. I went to stay in a rented room; my son sent me money from Romania but after that time, he gave me courage, yes, but he has a family to support. So, I ended up on the street. Doing the day I rode the whole tram route because it was cold outside. Then there was COVID; in the meantime my papers had expired and I couldn’t take tests or pick up the ones I had done before the pandemic.” (Interview with Petra, 66, Romanian, conducted online on 11 December 2020)

21Petra’s testimony shows how being employed in a poorly regulated workplace and the absence of effective safeguards for the protection of her rights made her condition as a sick woman even more problematic. Her experience resonates with those of many other migrant women in Italy and elsewhere, who are facing the situation of insecure jobs, where there are few or no protections against dismissal, no paid sick leave, no health insurance, and limited access to social security and related protection schemes (Boniol et al., 2019). In most cases, where workers had to be laid off to offset financial imbalances created by the pandemic, it was women in menial job positions, especially those who were ill, who got laid off first.

22Petra’s case confirms how migrant women’s health and illness trajectories and their economic, labour and legal status are uniquely and inseparably connected. The events experienced by this woman, like those of others facing the same conditions, differentiates her possibility of access to healthcare from that of native women or from those who have been able to appeal to social and economic resources for support. This aspect was highlighted by health professional Marta, an oncologist, who explained:

“Foreign women may find themselves in the situation of managing their illness themselves, even while continuing to work. Because they cannot afford to lose their jobs […]. They are very much alone in dealing with the illness and treatment because there is no, or no easily accessible, social security or other type of support.” (Interview with Marta, 50, Italian, conducted online on 29 December 2020)

23In this framework, we now discuss how the presence of social networks plays a key role in bridging these gaps, and in coping with the disease.

Migrants’ Social Network Facing Illness

24Some studies have investigated how migration processes take shape and develop thanks to and through social networks (Bilecen et al., 2018; Devillanova and Frattini, 2016; Boyd, 1989). They play a fundamental role, providing emotional, informative, and practical support during the different phases of migration (Pasian et al., 2020), starting from the choice of destination (Castles and Miller, 2003), until completion of the integration and inclusion processes in the new context (Chelpi-den Hamer and Mazzucato, 2010). In the early stages of immigration, it is common for networks to be mainly composed of people from the same cultural and linguistic background, while with the passage of time the network of connections and relationships tends to expand. In this sense, literature has noted how social networks can take on different characteristics (Putnam, 2000). Relationships with family members or with people belonging to similar social circles, such as compatriots, have been defined as strong bonds or bonding networks. Conversely, relationships that are occasionally maintained with people outside their own circle, including those with institutions, have been defined as weak links or bridging networks. While bonding networks are easier to access than bridging networks, they offer a limited range of information, as group members share the same resources. On the other hand, bridging networks are more difficult to establish, but they have the potential to offer new opportunities, thanks to the information and resources they can bring. It is important to note that these types of networks are not mutually exclusive (Ryan et al., 2008), indeed it is the combination of large and diversified networks that allows migrants to achieve better living conditions. Networks are not static, but should be understood as a fluid, dynamic and occasionally nebulous web of relationships (Ryan, 2021) that depends more on factors of context than the individual skills and characteristics of migrants, with the exception of linguistic knowledge, level of education, and economic capital (Lubbers et al., 2010).

25The role of social networks in accessing healthcare, although still little investigated, are important because they can act as a vehicle for the transmission of the cultural health capital that characterizes the immigration context (Shim, 2010; Næss, 2019), guiding and facilitating an understanding of medical practices and organizational logics and reducing the distrust that often constitutes a barrier to the use of social and health services by the migrant population (Feldmann et al., 2007). Healthcare trust/mistrust is not simply the direct outcome of individuals’ healthcare encounters but is also generated in immigrants’ interactions and exchanges with each other. Indeed, immigrants’ networks and social interactions and the distribution and mobilization of cultural health capital within them can shape health beliefs and practices (Næss, 2019). In the experiences of the women protagonists in our research, the presence or absence of social networks played a fundamental role as well.

26To highlight this aspect, we refer to the case of Emily, whose socio-economic profile was very different from that of our other informants. She had breast cancer and experienced local health services —her story highlights the relevance of social networks. Emily was formerly employed as a sales manager in a large company and ended treatment before the spread of COVID-19, telling us:

“Let’s talk frankly […] when there is a health problem it is essential to have contacts […] I had… I had, full confidence in the person who operated on me, whom I already knew because he was already my gynaecologist. I have a network, a network of people who follow me, so I said that I felt more than safe. Then yes, I consulted my friends in Milan, I phoned to say: I have the outcome of the surgery here, I’ll send you a scan. Can you confirm the result? At [city name of origin] we consulted the top person, the very best. My brother called the best person for the type of problem I had… I repeat that fortunately I have mastered the language, I am a person who has been able to study and has always held certain positions.” (Interview with Emily, 59, English, conducted online on 27 July 2020)

27The mobilization of a significant economic, cultural and social capital thanks to the presence of bonding and bridging networks, including transnational ones (Degli Uberti, 2021), allowed Emily to receive a quick diagnosis, easy access to health facilities, and timely and effective treatment. Aware that she is in a privileged position, given her perfect knowledge of the language and the cultural and social resources available that confirmed and endorsed the excellence of the care she received, Emily said she felt safe and had full confidence in the doctor who was treating her. Research has highlighted the importance of a feeling of trust for the migrant population in relation to healthcare, in particular a lack of trust has been identified as a barrier to accessing healthcare (Feldmann et al., 2007) and has been associated with a poor understanding of their state of health, less adherence to therapies, and generally reduced levels of satisfaction with services (Hsieh et al., 2010). Also, in the experience of Nadia confidence in health providers is particularly important:

“I took the car and I went to my friend Fatima, she saw my face and she understood that I wasn’t kidding and she said: ‘But you, noooo, you don’t have cancer, I had it’. She told me to go to [hospital name] where she had her operation, I said: ‘No, look I’m not going anywhere, because I’ve already done everything’ and my friend told me: ‘No, it’s not possible, you have to go somewhere else to check’. I said: ‘No, I have already done everything. I trust the doctor and I will be operated on at [name hospital]’. And I was operated on there.” (Interview with Nadia, 50, Moroccan, conducted online on 28 December 2020)

28This experience shows how the emotional dimension and, in this case, confidence in the physician, can guide the health choices of migrant women (Della Puppa et al., 2020). The suggestion to undergo a further examination coming from someone with whom she had a strong bond, an intimate friend, did not succeed. This decision went beyond the bonding network and its mobilization of cultural health capital and the factors that played a leading role and complemented each other included trust in the health institution, built up over the ten years the interviewee had spent in Italy, and trust in the doctor seen by the woman.

29Regardless of Nadia’s choice, the bonding network provided solid support, guaranteeing emotional and practical support throughout the course of the therapies she received. In this sense, networks are often responsible for filling gaps in areas that we would define as moving away from the strictly medical to those more properly described as social areas. For example, many of the women we interviewed reported that they had not received any guidance on accessing treatment support services (treatment, transport, etc.) and information on how to access relevant allowances, including disability allowance, as well as information about the networks—charitable, associative or voluntary—that could support them in dealing with bureaucracy. If in the pre-COVID era the role of support network appeared to be essential, with the advent of the pandemic this assumed even greater importance. Carmen said she could not book a check-up:

“I must say that I was helped a lot by the mother of A. [Italian mother-in-law], because there is this problem when you book on the phone, it is very difficult; in fact I had an appointment at the gastroenterology clinic […] COVID arrived and non-emergency visits were postponed, but I couldn’t re-book it; I waited half an hour, because it’s just a phone call, and then between them they can’t hear you well, you can’t. So it is very difficult.” (Interview with Carmen, 33, Nicaraguan, conducted online on 23 November 2020)

30One of the main obstacles to accessing healthcare for the migrant population is the so-called language barrier, since knowledge of the language is key to finding your way through Italy’s fragmented healthcare system. However, familiarity with Italian language displayed by Carmen during the interview did not seem to be sufficient to ensure her easy access to the simple booking of an appointment during the pandemic. Some research has shown that many routine consultations and non-essential procedures were cancelled especially during the initial outbreak, both to give priority to the management of patients affected by COVID-19 and to get health workers from other facilities transferred to COVID wards, either to avoid, or at least reduce, the risk of spreading the infection within hospitals (Boza-Kiss et al., 2021). Despite mastering Italian, Carmen reported that she could not manage to book an appointment with a specialist by phone because of the long wait as we; as the difficulties in understanding that occurs when communication is by telephone and not face to face. Drawing on a bonding network that also represents a bridging network, namely her Italian mother-in-law, Carmen overcame the obstacle to arranging her visit. In this woman’s experience, the mother-in-law played the role of “bridge-builder” (Næss, 2019), taking care of booking the visit and providing her daughter-in-law with access to the health institution. The obstacle encountered by the young migrant was not exclusively due to linguistic problems, but reflects the wider and more complex system of codes and practices that allow a native woman to wait for a long time for a call to be answered, to respond to the telephone operator’s questions, to understand the rationale behind the change in procedures following COVID-19, and to reformulate requests adapting them to changes and possibly suggesting solutions in order to achieve the objective of arranging an appointment.

31In those cases where migrant women participants could not count on a network of facilitation and intermediation, as in the case of Carmen, the impossibility of going in person to the health facilities during the pandemic led to a complete halt in their treatment, leaving them in limbo and waiting for the end of lockdown. This was the case for Petra, introduced in the last section. Petra could not rely on a support network, to the extent that when asked if she had friends or acquaintances, she answered:

“Yes, but a few […] you know how we say, ‘when you have money you have mother and father, when you have no money you have neither mother nor father’. This is what happened to me.” (Interview with Petra, 66, Romanian, conducted online on 11 December 2020)

32When Petra discovered she was sick, she had a job, but the treatment she had to undergo caused her dismissal and a decline in her economic situation. Her lack of savings and the absence of a network that could offer her shelter caused the deterioration of her living conditions, which also impacted her access to healthcare services. She was forced to live a marginal life, and it was only through a chance encounter that she was able to find refuge and slowly resume her care and life:

“Once at the kitchens [city soup kitchens] I saw a man who looked at me, I always cried, and he asked me why I was so sad, what had happened and I say: ‘Look I have no money, at night I sleep in the emergency ward of the hospital and I do not know where to go’. He says: ‘Be calm, tonight, you go there [city night shelter] and tomorrow we’ll see’. And so it happened that in the evening he took me here and then I made documents to live there with the social worker.” (Interview with Petra, 66, Romanian, conducted online on 11 December 2020)

33Only with support from the social worker could Petra find the opportunity to restore her legal and administrative position to access necessary healthcare and check-ups. The absence of effective bonding and bridging networks able to support women in facing the disease and its consequences emerged vividly from this narrative through the idiom used by the interviewee: “When you have money you have mother and father, when you have no money you have neither mother, nor father”. The precarious and vulnerable conditions common to the lives of migrant women seems to generate, among the sparse bonding networks that are created, a kind of solidarity limited to the condition of well-being. Rather than an unwillingness to help, this appears to be due to the lack of economic, social and cultural capital available to these women, who do not have sufficient resources to cope with the emergence of critical events in their lives. The loneliness and isolation experienced by Petra also appeared to increase during the pandemic—she was unable to count on the help of friends or acquaintances or to renew her health card; and she could not collect the results of examinations carried out weeks before. The impossibility of claiming health services contributes to a de facto stratification of the health system (Joseph, 2017). It was only a fortuitous encounter with a bridge-builder who could show the way that allowed this woman to regain control over her life and care. Literature has already pointed out that COVID-19 hit the migrant population hardest (Devillanova et al., 2020; Zambrano-Barragán et al., 2021) and the experiences of our participants seems to confirm this. Social networks play a decisive role in addressing critical issues, and if they are weak or non-existent, access to paths for help is severely affected.

34While the nationality and the presence or otherwise of a universalistic health system in the country of origin can influence the experience of recently arrived migrants in accessing health services, these dimensions seemed less pertinent in the experiences of our interviews. Our participants had lived in Italy for many years, and they had regular work permits when the disease appeared. Nevertheless, the formal recognition of rights and possibility to access health services did not correspond to quick and substantial access for them. Whereas many factors contribute to origin this situation, a considerable role is played by the presence of bonding and bridging networks, able to facilitate access to the particular repertoire of cultural skills, verbal and nonverbal competencies, and interactional styles that can influence healthcare interactions at a given historical moment (Shim, 2010). In many cases the lack of bonding and bridging networks has been overcome by resorting to virtual networks, as shown in the next section.

Coping with Cancer through Digital Networks

35Several studies have highlighted how the use of digital social networks (such as Facebook, X/Twitter, Instagram) has characterised how health communication is carried out (Han and Wiley, 2013). Public health facilities and medical professionals included in our research also used digital networks to provide patients with information about the treatments and services available and sometimes individual support. New communication technologies have become central to regular practices of work and intimacy in many such cases. Sara, a psycho-oncologist, added that during the pandemic these tools were indispensable “not only to maintain relationships and make patients feel a presence, but also to continue the therapeutic process through weekly Zoom meetings”.

36In the therapeutic relationship with migrant women, the use of such tools has been facilitated by their familiarity with various modes of communication such as mobile telephony and short message service (SMS), Internet and e-mail, as well as digital transmission. As theoretical contributions and empirical research have pointed out, increasing virtual mobility and social network sites characterise the lives of many contemporary migrants and the conditions of being a migrant. Our informants represent in this sense a perfect example of the so-called “connected migrant” who is both internationally and digitally mobile (Diminescu and Pasquier, 2010; Kissau and Hunger, 2010). The use of technology allows them, first, to choose from a broader set of migration destinations thanks the possibility of finding labour market information. Secondly, it allows them to communicate more effectively with people and places left behind and to be present despite the distance. Finally, they can address some aspects related to the illness they experienced while in Italy.

37During the research, interviewees pointed us towards Facebook forums dedicated to different forms of breast cancer that some of them diligently follow. Over a period of three months, we monitored the conversations within some of these groups where people mainly exchanged experiences of the course of the disease and the treatment, trying to identify their characteristics and objectives. By following these groups, our goal was to understand why our informants spoke about them as fundamental tools for coping with the disease and for filling certain structural gaps in the care system that the pandemic had increased. The Facebook groups have titles in Italian that refer to a pathology and are frequented by patients and/or former patients and not by medical doctors or health professionals. Participants have different nationalities (mainly Italian, Romanian, Moldavan and Russian), and have direct or indirect experience (as family members) with oncological disease. The ones we monitored were mainly attended by women since we selected the groups dedicated to the prevalent pathology in our interviews (breast cancer), which is predominantly—though not exclusively—experienced by women.

38The online dialogues were in Italian and varied in length; they were usually stimulated by a question or a report on a visit or a medical report just received. Some interlocutors made only brief comments, while others took the opportunity to tell of their personal experience. These narratives, when considered separately, are partial and fragmentary, but when read as a whole, they provide a broad and meaningful storyline. They represent an “effective way” of communicating the meanings attributed to the illness (Kleinman, 1988: 50). However, these are not true “illness narratives” in the sense that Kleinman described them. They are rather “small stories” (Bamberg and Georgakopoulou, 2008) used primarily as an “entry point” into a larger community. Moreover, these narratives have a plural structure (Kangas, 2002) defined by the interaction and contributions of all participants. Due to their interactive and conversational character, these narratives take the form of a collage of non-linear stories—because there may be interventions that go “off-topic”—without a timeline because it is possible to intervene from a distance. However, if read in terms of their interconnectedness, all these fragments create a convincing plot, interwoven by the events and points of view of everyone who explains “what has happened or is happening, or could happen in the future” (Ochs, 2004: 269).

39The most regularly recurring aspect of these virtual exchanges is the reference to a distinct community of people experiencing a very specific physical, psychological and social condition caused by cancer. Participation in the Facebook groups reaffirms membership of this community as a means of resistance and negotiation with the difficulties, but above all it is an affirmation of a new “normality” (Goldstein and Shuman, 2012). The testimonies collected, as well as those posted online, place great emphasis on this aspect: the disease is not removed but openly faced as an “enemy”. Strength, courage, and opposition to fatalism (Drew and Schoenberg, 2011) are the sentiments most often evoked to represent the temperament of “sick people” in opposition, if not to a real stigma, to a certain widespread vision of the “cancer patient” as a passive subject, who is not to blame for what has happened and who, above all, is condemned to an ineluctable outcome. This theme was also recalled by the women interviewed. For example, Maria, had to face not only a serious disease but above all the idea that her fate was already sealed. In her experience, this point of view was widespread in her country of origin where the inability of public health services to take care of citizens causes lower survival rates. This affected her sociality because it implied the very possibility of talking about cancer:

“In my country when people hear the word ‘cancer’ they immediately think ‘fatal’. and they think you’ve already got a foot in the grave. […] And thus you lose your friends because they look at you… not with contempt, but they all think: ‘Oh, poor thing, you’re ill!’ and you want to avoid these things and so you pull back. Because there, in Moldova, everything has to be paid for and if you have a cancer, you have to look for a good specialist and the money to be lucky enough to get well. Whereas here in Italy it’s not like that.” (Interview with Maria, 51, Moldovan, conducted online on 30 July 2020)

40Reference to the country of origin was very sporadic in online dialogues. However, when participants did refer to it: even if they used the word “culture”, they did not refer to a culturally specific view of cancer, but rather the structural conditions that influence its treatment. As in Maria’s case, reference to the country of origin serves to emphasise the gap between the level of quality of care services in Italy and those available to those who remained at home, where they believed the public health system to be deficient. Moreover, it must be considered that migrant women often do not inform family members in their country of origin of their illness due to distance, the difficulty of immediate reunification, and their understandable worries it would encourage. These latter factors amplified a condition of loneliness and isolation that the pandemic greatly exacerbated. It was precisely during this period that online groups took on a crucial role, when the limitations of movement and social contacts stretched the time and loneliness of patients who, for example, were undergoing post-operative care. Digital networks also enabled an exchange of information/questions made more complicated by the cancellation of many non-essential health services and by the impossibility of going in person to the health facilities during the pandemic. Thus, Maria started joining Facebook groups to be able to “talk” with people facing the same disease but with a very different attitude:

“I joined a group on Facebook and there you find women with really incredible strength! When you talk about your problem they say ‘Come on! Come on!’ They are great, and that’s really useful. Many of them have lived through cancer and only they can understand. Because those who are not going through it cannot understand you 100%. Whoever is going through this, only this person can understand you. And in these groups, during the illness, they don’t look at whether you are Moldovan, foreign, or Italian: we are all the same. And for everyone there is a good word, encouragement.” (Interview with Maria, 51, Moldovan, conducted online on 30 July 2020)

41Many participants found not only comfort and encouragement in these groups but also information about a therapy that had not always been clearly explained in the doctor-patient relationship. Since communication is filtered by distance and due to the heterogeneity of the people participating, the forums become a “place” in which to ask questions without fear or embarrassment. The overlapping testimony of Viorica, and that of a retired Italian oncologist emphasises this point. On the one hand, there are the needs of patients to which services are not always able to respond and, on the other, there are the broader changes in public health. Talking about the friendship she established with a compatriot suffering from the same disease through the Internet, Viorica said:

“Through Facebook I met a compatriot of mine who also had surgery. I have this circle of three or four friends who, when something happens, talk to each other, advise each other, exchange information. For example, I’m going to have an operation soon and she called me and said: ‘Do this, do that, buy this kind of bra you need for after the operation’. This is something I would never ask a doctor.” (Interview with Viorica, 44, Moldovan, conducted online on 23 July 2020)

42Patients are not always able to explain their fears and needs to doctors, who they often find to be formal and hierarchical. They are, therefore, afraid to ask questions which they consider “unimportant” in relation to medical competence. However, this reflects not only the attitudes of the patients but also those of the health services. Marco, a retired oncologist, explained the reason for this in relation to the impersonal nature of health services in general:

“Doctors have less and less time, desire, space to devote to problematic patients. When I say ‘problematic’, I am not expressing a criticism, but I am identifying that patient who requires more time because he does not understand or pretends not to understand, or just does not understand because he comes from another country and has another education. Now, unfortunately, in the various specialisations in medicine and in oncology, we try to treat the acute fact. If a person goes to the emergency room because he has kidney colic, the kidney colic is treated. If he also has a tumour, it does not matter: we treat the renal colic, try to solve that and then send him home. That is what the doctor-patient relationship is now. Very compartmentalised. Very impersonal, very neutral. […] [Instead] when you take care of the patient, you have to take care of him as a person.” (Interview with Marco, 72, Italian, conducted online on 20 December 2020)

43In the doctor-patient relationship, the medical problems of the suffering person take priority over bedside manner. This implies that much of the subjective, everyday experience of the disease is neglected and needs to find other ways to express itself. Online groups respond to this objective by restoring relatability and visibility to the deep existential questions and troubling experiences of illness.

Conclusion

44This paper has analysed the access to health services during the pandemic for migrant women with cancer and highlighted a certain stratification of the health system. Although the local level of care appeared to be inclusive and of a high standard, marked differences emerged between patients who have recourse to a range of social and economic resources and those who do not. Studies have highlighted how socio-demographic, economic, and territorial dimensions influence an individual’s use of health services and in particular how health inequalities related to income, migratory status, and gender can develop. The experiences of some of our informants confirmed that effectiveness of cancer therapy cannot be considered separately from the concatenation of these different factors.

45The COVID-19 pandemic, intersecting the biographies of individuals in a major way, represented a further problematic element in the experiences of migrant cancer patients. The health emergency was indeed also a labour emergency. Most women migrant workers are occupied in low paying jobs in both the formal and informal sectors. This means that in times of an emergency such as COVID-19, the loss of work implies not only the loss of income and other socio-economic safety resources, but also the possibility of making full use of health services. Being employed in unsafe, dangerous and poorly regulated workplaces, in the absence of effective safeguards to protect their rights, has exposed migrant women to increased uncertainty. Furthermore, a lack of services, mainly outside the purely medical context, has affected different aspects of women’s experiences of disease—the personal and social, the physical and the psychological—in these areas the inequality between women who can call on social and economic support networks and those who cannot—migrants versus natives—was more evident.

46The role played by social networks, bonding and bridging in providing support during the course of disease and therapy therefore assumes great importance, since on the one hand, it highlights how the network can help to fill some of the structural gaps in the system, while on the other hand, it makes clear how inequalities can be further accentuated if networks are not willing or not able to share social, cultural, and economic resources. Some women identified social networks as a privileged channel, giving a daily and experiential dimension to the therapeutic process, which is sometimes absent in interactions with health professionals.

47Driven by a desire to share their experiences with others, and unable to do so due to isolation, the protagonists in our research developed an agency with the aim of normalising what was happening. Moreover, this process allows their subjectivities to be integrated and, as we have seen, to complement the medical dimension. Social networks can interact in a fluid and processual way, or conversely can never meet. It is an individual choice, which is also anchored to the individual social and cultural resources, to create connection among them or use them as separate spaces of experience. In any case, social and virtual networks appear to be fundamental resources for coping with the cancer experience. This was even more true during the pandemic period and because of the impact it had on migrant women’s relational, economic and working lives.