1Since 2015, the French authorities have stepped up controls at the Franco-Italian border, notably close to Briançon in the Hautes-Alpes. As a result, migrants coming from the Mediterranean Sea or via the Balkans route have been forced to take high mountain paths, mostly at night, in order to avoid police patrols and controls targeting foreign nationals to send them back to Italy. At the Alpine border, just as in other border areas, the French state reveals the “biopolitical” dimension (Foucault, 2008) of border controls, in that they “involve the exercise of power on the bodies and lives of the persons targeted” (Guénébeaud and Lendaro, 2020). This border regime faces different forms of opposition, first from migrants thwarting border controls, and second from groups of citizens who are challenging the way in which migrants are treated at the border.
2In Briançon, the securitisation/humanitarian rhetoric of migration policy is structured around specific issues, directly linked to the high-mountain environment in which the border control apparatus is deployed. This article analyses the power relations between the French state and activists in relation to the risks involved in mountain crossings, endangerment, rescue and access to healthcare: how are these concepts used by the state to justify its practices, but also by certain activists to resist the border regime? We will see how these conflicts linked to the control exercised by border police over migrants’ bodies, and resistance through practices of rescue and care, shed light on a set of relations of power and domination that shape the border space.
3First, we will discuss how the concepts of “risk”, “danger” and “shelter” are used by the French state to justify its mission of combating irregular migration, even while access to healthcare for migrants is determined by the discretionary practices of the police. Second, we will show the impact of the border on migrants’ health, and the extent to which a listening and caring attitude can counteract border violence. Finally, we will look at how attempts to protect(sanctuariser) access to healthcare in the mountains by organising maraude-outreach patrols - come up against the border regime, and how volunteer health workers negotiate care for vulnerable migrants.
- 1 Under the Industrial Conventions for Training through Research (Cifre) scheme, companies and organi (...)
- 2 The Terrasses Solidaires centre was created in 2021 and hosts the humanitarian organisations Refuge (...)
4These reflections are the product of a long-term ethnographic study that has been conducted since 2021 as part of a Cifre1 thesis project with two non-profit organisations, Tous Migrants and Médecins du Monde, in dialogue with two health workers volunteering as part of Médecins du Monde’s “Transalpine Border Migration” programme in Briançon. Our study period covers three years, from winter 2020–2021 to winter 2023–2024. The analyses are based on several sources: 122 interviews with migrants, 38 accounts of maraudes, supplemented by 8 interviews with maraude volunteers (including 4 volunteer health workers), 3 interviews with police and gendarmerie officers, and accounts from participant observations of maraudes and medical consultations at the Terrasses Solidaires centre.2 Maraude activities were continuously monitored throughout each winter, and medical data, gathered from a sample of 1,843 consultations, was provided by Médecins du Monde. We have also analysed a large number of press articles, along with other documents supplied by community organisations.
5France reintroduced border controls with Italy in 2015, in application of Articles 23 and following of the Schengen Borders Code. Surveillance by French border police (PAF) at the Montgenèvre pass, Modane train station and Fréjus road tunnel was stepped up at the same time. Simultaneously, more and more migrants were attempting to cross this border, via the Col de l’Echelle and the paths around the Montgenèvre pass. These places, as well as the passes leading to the Cervières valley, have become high-risk crossing areas for migrants without a visa or residence permit, who are exposed to identity checks (Bachellerie, 2020; Charaudeau Santomauro, 2020; 2022).
Figure 1: Main migrant crossing points from 2016
6In order to control the movement of “illegal foreign nationals” – referred to as “ESI” (etranger·ères en situation irrégulière) by the French Ministry of the Interior and security forces – “spatial policing mechanisms” (Guénébeaud, 2021) are assigned to police forces on the ground: spotting people identified as “ESI”, chasing them, arresting them, detaining them and deporting them to Italy. This system has a filtering function (Le Courant et al., 2019), mobilising “a construction of racial and ethnic criteria” to identify and “separate bodies who are presumed to be in order from bodies presumed to be in an illegal situation” (Guénébeaud, 2016). At the border near Briançon, studies have shown how the processes of domination and racialisation (Freedman and Tyszler, 2023) produced by the policing apparatus establish a “social and racial order” (Bachellerie, 2020) that exposes migrants to the violence of this border space (Del Biaggio et al, 2020; Defossez and Fassin, 2024; Tous Migrants, 2023).
- 3 Mathieu M., 2020.– “Hautes-Alpes : un policier de la PAF renvoyé devant le tribunal”, Mediapart, ht (...)
- 4 “Respect des droits des personnes migrantes à la frontière intérieure franco-italienne : le Défense (...)
- 5 Ibid.
7Police violence, of both a verbal and physical nature, was common until 2019, but has subsided since the conviction of two officers in 2020.3 Nevertheless, a form of administrative violence, involving failure to respect the rights of foreign nationals and the applicable legal framework, has persisted, becoming the “ordinary way in which the institution operates” (Defossez and Fassin, 2023, p. 253). In April 2024, France’s Defender of Rights ombudsman issued an unprecedented framework decision (Défenseure des Droits, 2024) that concluded “with concern” that “there are procedures and practices that do not comply with the Return Directive, European law and national law”.4 This decision also highlighted “substantial and multiple infringements of the rights of arrested persons, from police controls through to their removal from the country”.5
- 6 BFM DICI, 2021.– “Migrants aux frontières : ‘Je suis là pour appliquer la loi, appliquer les textes (...)
- 7 Letter from Dominique Dufour to Médecins du Monde, 27 December 2022.
8The border apparatus includes a dual “securitarian” and “humanitarian” dynamic (Cuttitta, 2015; Sanyal, 2019) that can be observed in the discourse of the Hautes-Alpes prefecture on the border. Until the Conseil d’État decision of February 2024, the prefecture maintained that its “primary objective” 6was “the closure of the border”, as Martine Clavel (the prefect until August 2022) stated in December 2021, while on 21 September 2023 her successor Dominique Dufour announced that the stepping up of controls was intended to “seal the Franco-Italian border in the département” (E.F., 2023). This stance of closure was coupled with a discourse in which migrants were presented as victims of smugglers, and as being reckless in their risk-taking. The prefect thus described migrants as “vulnerable people […] who, encouraged to brave the gravest dangers, prefer to expose themselves to all kinds of risks, losing themselves in the lure of illegal migration […] a source of sadness and misfortune for those who embark upon it”.7 It should be noted that the prefect does not specify here either the risks to which migrants “prefer to expose themselves” (in his view they become responsible for any ‘misfortune’ that might befall them), or who is responsible for them taking these risks. Responsibility is attributed to the migrants themselves, a stance echoed by a senior national police officer, who considered that at the border, people who have crossed the Mediterranean are no longer in any danger to their lives – insofar as they are in Europe – “apart from the danger to which they expose themselves” (extract from interview, May 2024).
- 8 See Médecins du Monde and Tous Migrants, 2024. - SANTE ET FRONTIERES - Stigmata of a crossing on bo (...)
9However, as various studies have pointed out (Bachellerie et al, 2023; Defossez and Fassin, 2023), policing practices at the border contribute to producing the dangers to which migrants are exposed: the border is not inherently dangerous, since thousands of commercial hauliers, residents and tourists cross it unhindered on a daily basis. The violence of this space is the result of practices of control and repression that exploit the mountain space to turn it into a tool of coercion (Del Biaggio et al, 2020) via practices such as hiding under tree cover, using high promontories as a position for surveillance, chasing people by day or night, taking people by surprise in the woods, or trapping them on a path using a pincer movement.8 The vulnerability of people as they make this crossing is further heightened by their long migration journey and by previous border crossings, associated with confrontations of varying degrees of violence with the police. This vulnerability is even greater for those groups of people, albeit in the minority, who are already inherently vulnerable because of their age – such as young children or older adults travelling as a family – or physical condition – such as pregnant women – and are then crossing Alpine passes at an altitude of over 1700 metres.
10Yet what pushes migrants to venture into the mountains is precisely the large police presence, which is made of mobile gendarmerie squadrons, sometimes backed up by soldiers from the anti-terrorist Operation Sentinelle, mobilised to support the PAF. While the number of personnel assigned to border controls in the Briançon area has varied over time depending on the political context, at certain points it has consisted of over 200 police and gendarmerie officers, made up of around 60 PAF officers and a mobile gendarmerie squadron (averaging 100 members), occasionally reinforced by a second squadron (Defossez and Fassin, 2024, p. 231). The police have substantial ad hoc technical resources at their disposal to detect people in the mountains, including thermal imaging binoculars, snowmobiles, skis and snowshoes, all-terrain vehicles, quad bikes and, since summer 2023, drones. The practices of “ambush and pursuit” (Defossez and Fassin, 2024, p. 202) are exercised to varying degrees depending on the mobile gendarmerie squadron, and are liable to scare migrants, making them more likely to impulsively flee and to fall, increasing the danger of mountain crossings (Bachellerie, 2020).
11At the same time, the mobile gendarmes have been instructed to make their operations safer by “not intervening in high-risk areas” (in the words of prefect Dominique Dufour), but only in “secure” terrain (Krafft, 2023). Each new squadron also receives training about the particular risks of the mountains on their arrival in Briançon. The mixed message of this contradictory double injunction – intercept, but do not pursue – raises questions. One gendarmerie officer conceded that when the “mission [is] to prevent access to the border, if someone tries to outrun us, we may well think of running after them, and ultimately, tragedies occur” (extract from interview, October 2023). This mixed message is reflected in the ambiguous discourse on the aims of the mission, in which risk prevention becomes a recurring argument. For the head of the local national police force, “it’s about intercepting illegal migrants for control purposes, but it’s also a rescue mission, because they put themselves in dangerous situations” (extract from interview, May 2024).
12Since controls were re-established in 2015, the Hautes-Alpes prefecture has also made abundant use of the idea of “danger at the border” to present itself as pursuing a sheltering mission. People arrested in the mountains are held at the Montgenèvre PAF station in an temporary cabin structure until they are sent back to Italy by the Italian police or the Red Cross, who drop them off in Oulx (Anafé, 2022). The prefectural authorities do not recognize this structure as a place in which migrants are deprived of their liberty, but as a place of “shelter” that is “made available to non-admitted persons, designed to give them a warm place to wait in” (Faure, 2019). Moreover, the prefecture paradoxically uses the humanitarian aspect of the facility to refuse access by non-profit organisations (ibid.), which have condemned it as a place of “illegal detention” (Anafé, 2022) in which people are kept under “bodily coercion” (Fischer, 2012).
- 9 “Le 8:30 avec Dominique Dufour - Border Force.”, Alpes 1, consulted 11 March 2024, https://alpesdus (...)
13This “securitisation-humanitarian dialectic” (Davies et al, 2024) is particularly prevalent at the Alpine border, where the topography (rugged terrain, altitude, slopes, ravines, etc.) and climatic conditions (snow, wind, sub-zero temperatures, etc.) of the high mountains can be mobilised to turn arrests into rescue operations. However, the humanitarian intentions attributed by the authorities to the resulting migratory control system are regularly contradicted in its own speeches: the prefect, for example, supports the objective of the Border Force, set up in summer 2023, to “arrest as many people as possible”.9 In addition, institutional reports published on the fight against irregular migration (Cour des Comptes, 2024; Gonzalez, 2023) do not include any humanitarian aspects relating to giving migrants shelter, and the performance bonuses of PAF and gendarmerie officers are based on the number of arrests made at the border (Defossez and Fassin, 2023, p. 237).
- 10 Letter from prefect Martine Clavel to humanitarian organisations, 20 May 2022.
- 11 Letter from prefect Dominique Dufour to Médecins du Monde, 27 December 2022.
- 12 See Médecins du Monde and Tous Migrants, 2024. - SANTE ET FRONTIERES - Stigmata of a crossing on bo (...)
14The “sheltering” mission highlighted by the prefecture also appears to be contradicted by the actual conditions under which people who are arrested and require treatment are granted access to a health professional. The prefecture notes that the police can call the Emergency Medical Assistance Service (SAMU) by telephone “if this is warranted by the state of health of the foreign national”,10 and ask for assistance “whenever the situation requires it, and the intervention of medical personnel is requested when necessary”.11 Nevertheless, it appears that access to a health professional remains discretionary (Defossez and Fassin, 2024) and random, even when a detainee asks to see a doctor or is in obvious pain, for example after a fall. Our research found a great deal of inconsistency in police practices with regard to granting access to a doctor for people with vulnerabilities (such as pregnant women, young children, older adults, those with a history of high-risk disease or cardiorespiratory frailty) who are held at the PAF station, where there does not seem to be any routine assessment of people’s state of health, even when they have spent several hours in the mountains, under-equipped, at night. While some critical cases are transferred to the hospital in Briançon, some of the people we interviewed reported that they had asked to see a doctor, or had shown visible signs of weakness or pain, but had been sent back to Italy despite their request, without receiving any particular care.12
B, a young Afghan woman travelling with her husband and two children (8 months and 3 ½ years old), was pushed back four times before making it to Briançon. She told us:
“The second time, we also left from Clavière, this time we took a different route, we walked for 8 hours, right by a river. Close to Briançon, I was so cold and scared for my baby that we went back up to the road, where the police stopped us. At the police station, […] my baby was crying a lot, I felt unwell, my husband said to call a doctor, but the officer said there was no doctor here, that I was lying. I fainted briefly, the officers patted my cheek to wake me up and asked me if I was pregnant, to which I replied to no. Again, they said they weren’t doctors, and that there weren’t any anyway. Then the Red Cross dropped us off in Oulx.” (Extract from interview, February 2022)
T, a Sahrawi man, also told us:
“We were stopped by the French police, we ran, they ran, I had a bad fall down a slope, my eyebrow was bleeding, I had severe pain in my knee and ankle, I could no longer walk. […] At the police station, they just took our fingerprints, and I got a drink and some crisps. I asked for a doctor, but they told me it wasn’t their job, they were there to take our fingerprints […]. It was in Oulx that I was treated for my eyebrow and my knee. I crossed the border again two days later with my knee hurting a lot, but I managed to get through. I received treatment in Briançon, I was able to go to hospital and have an X-ray, it turned out to be a double sprain.” (Extract from interview, August 2023).
15However, the ability of the police to assess the vulnerability of migrants is questionable. Gendarmerie and police officers do not have in-depth medical training, and the criteria for calling the emergency services are not clearly defined, yet it is the police who have the power to determine the degree of vulnerability of migrants: who is in danger and who “deserves” (Malakasis and Sahraoui, 2020) to be rescued and receive care, who can have access to French territory and hospital care and who must be sent back to Italy. The severity of the physical consequences of exposure to the cold are also not necessarily immediately apparent. The latest medical knowledge of frostbite, for example, shows the importance of taking rapid therapeutic measures to avoid complications, in particular infection, and of regular re-assessment. Care and monitoring of this kind may be difficult to provide in the PAF’s cramped premises.
Figure 2: Number of refusals of entry by the Montgenèvre PAF compared to the number of migrants granted access to medical care after their arrest
Hautes-Alpes Prefecture
- 13 The same person may be refused entry several times, even though the majority of migrants come over (...)
16The very small number of migrants who were granted access to medical care after being arrested at the border, compared to the total number of refusals of entry13 issued by the PAF (Figure 2), raises questions in the light of the crossing conditions described above, and seems to confirm that health professionals are rarely called in to assess the state of health of migrants.
17Far from submitting to the border regime, migrants are not simply vulnerable. They use their bodies – “illegalised” (Bauder, 2013), endangered, wounded and bruised – as a means of “resistance” (Guénébeaud and Lendaro, 2020): hundreds of people cross this stretch of mountains every month, walking for hours in difficult conditions to reach Briançon. By defying the order in this way, by appropriating the space and subverting the control apparatus, they exercise a form of “spatial disobedience” (Tazzioli, 2018), using the mountain space to evade patrols. For example, one young man explained that he had sheltered with his companions for a whole night in a ski resort hut designed to store snow cannon equipment (field notebook, October 2023).
- 14 See Médecins du Monde and Tous Migrants, 2024. – “SANTE ET FRONTIERES – Stigmates d’une traversée s (...)
18But these crossings are very demanding, as people have to walk for long hours in the mountains, often at night, in conditions that can be very stressful.14 In winter, many of the migrants encounter snow, ice and sub-zero temperatures for the first time in their lives. In summer, as the snow melts, the number of possible routes increases, and people take more remote paths at high altitude, which lengthens their walking time and increases the risk of disorientation and dehydration.
19Before they cross the border, people stop off in Oulx (Piedmont) at the Rifugio Fraternità Massi, where the humanitarian organisation Medici per i Diritti Umani (MEDU) runs a medical service. The main health problems seen at Oulx, as reported by MEDU doctors (Goci and Tarenghi, 2023), are illnesses related to the journey, lack of medical care or violence experienced in the Balkans, Libya or Tunisia. In Briançon, two studies (Lecarpentier, 2019; Bachellerie et al., 2022) found that in 2017 and 2018, the main health problems diagnosed in migrants who had crossed the Franco-Italian border were the result of physical trauma (36%), mainly linked to direct border crossings in the mountains (bruises, haematomas and falls), and more specifically cold-related illnesses.
20Data collected by Médecins du Monde between January 2021 and December 2023 (Figure 3) confirm that the majority of their consultations are related to physical trauma (42%). Other health problems, such as infections (22%) or chronic diseases (8%), are generally longer standing and linked to the migratory process. Injuries caused by physical traumas consist mainly of musculoskeletal problems (sore muscles, sprains, fractures) and wounds (Figure 4).
Figure 3: Migrants received at the Médecins du Monde clinic: main reasons for seeking medical treatment from January 2021 to December 2023
Médecins du Monde
Figure 4: Injuries linked to physical trauma presented by migrants who consulted the Médecins du Monde clinic from January 2021 to December 2023
Médecins du Monde
21During the study period, 50 cases of frostbite injury were recorded, representing 6% of all injuries to the musculoskeletal system (physical trauma) (Figure 4). Although rare, advanced frostbite (second and third degree) can have extremely serious consequences. For example, in February 2023, J, a Gambian man, finally made it to Briançon after being pushed back on two occasions. He was rapidly admitted to hospital with his travelling companion, who was transferred by helicopter in a hyperbaric chamber to a specialist unit in Lyon. Both had severe frostbite, J on his left hand (four fingers) and right foot (two toes). A few months later, he had to have a phalanx and part of his toe amputated. Médecins du Monde tries to prevent the risk of frostbite as early as possible, via outreach patrols in the mountains (see below) and by training those on duty overnight at the Terrasses Solidaires centre to give foot baths to people arriving from the mountains.
22In June 2024, two families, including two pregnant women and a number of very young children, spent almost 48 hours in the mountains with no specialist equipment, after getting lost and climbing to an altitude of over 2,000 metres. In August 2024, a young man was found dead on a path, and in October two men drowned in the river on the outskirts of Briançon, bringing the number of people who have died trying to cross the border between Val di Susa and Briançon to a total of 14, and the number of deaths in the Alps since controls were re-established in 2015 to a total of 139.15 Although deaths remain rare, the border exhausts and injures people, in a “systematic debilitation” of bodies, as part of the biopolitical control of borders, “that forms the central apparatus of control and coercion of racialised groups” (Davies et al, 2024).
23In these circumstances, the practice of care represents an “act against the flow of securitarian migration policies” at the border (Tisserand, 2021). Since 2016, health workers have mobilised to meet the care needs of people arriving from the border, leading to the establishment of a “migration medicine” (Tisserand, 2021) in the Briançon border area.
24When they arrive at the Terrasses Solidaires centre in Briançon, migrants are provided with shelter, three meals a day, and access to toilets and showers. Meeting their basic needs for a few days in this way gives migrants time for physical and mental rest, enabling them to continue their journey in better conditions. Since 2017, Médecins du Monde and Refuges Solidaires have run a clinic at the Terrasses Solidaires centre, staffed by volunteers, nurses and doctors, in collaboration with the free medical centre (PASS) at the hospital in Briançon, which provides access to medical and nursing consultations for anyone without social security coverage. In 2018, the PASS also set up a mobile nursing team working two half-days a week, then every morning at the Refuge and later the Terrasses Solidaires centre. This outreach approach aims to reduce the number of people with no access to medical care, since outside the Terrasses Solidaires centre, the threat of the police can act as a barrier to accessing hospital care (Cellier, 2019).
25In contrast to the police hunts for bodies in the mountains in order to expel them, these medical consultations are centred on the right to respect for physical and psychological integrity. This integrity has often been undermined during the migratory journey, due to the living conditions and sometimes inhumane treatment that these “crossed bodies” (Tisserand, 2021, p. 192) have endured. Due to a lack of time, uncertainty about the future and precarious living conditions, the medical service mainly consists of providing reception facilities and alleviating symptoms: the curative or aetiological approach normal in medicine tends to be restricted to situations in which there is a risk to life or function in the short to medium term. However, these consultations also include an important listening and receiving component, coupled with a physical examination by health workers to assess vital functions. These moments of attention devoted to the symptoms and bodies of migrants can be an opportunity for them to begin reappropriating their body, and to re-anchor themself physically and psychologically (Tartaglia, 2021; Desforges, 2021).
26Higher up from Briançon is another space in which resistance through rescue and care takes place: the border zone of the Montgenèvre pass. A maraude group was formed back in 2016 to rescue people who might be in difficulty in the mountains (Antoine et al, 2021; Vergnano, 2021), and in 2019 this was joined by a mobile shelter unit (UMMA), as part of a risk-reduction strategy. This unit is made up of members of Médecins du Monde and Tous Migrants and has a Médecins du Monde-flagged vehicle. As part of a set of “mobile infrastructures of solidarity” (Tazzioli, 2020), these volunteers roam the French side of the mountain every night in winter and occasionally in summer, offering migrants hot tea, warm clothing, shelter at Briançon’s Terrasses Solidaires centre depending on their needs, and referral to hospital if necessary.
- 16 Letter from prefect Dominique Dufour to Médecins du Monde, 27 December 2022.
- 17 As everywhere in France, and particularly in Calais, the periods of lockdown and curfew due to the (...)
27But this humanitarian initiative, despite being recognised as legitimate by the prefect,16 has been met with intimidating police practices: repeated identity checks, tailing, verbal intimidation and fines (Defossez and Fassin, 2024; Tous Migrants, 2023). Tous Migrants, Médecins du Monde and Anafé have regularly appealed to the Ethics Office of the Defender of Rights on this subject, and spoken out against these obstacles to humanitarian practices. While practices of intimidation have decreased since the winter of 2020–2021,17 the same police forces repeatedly subject the same maraude volunteers to identity checks. These recurrent checks – although the presence of the police and the frequency of identity checks vary greatly from one week or one day to the next – are part of a continuum of practices criminalising solidarity in Briançon (Defossez and Fassin, 2024). Unpredictable and random, these checks are part of a dynamic of surveillance and constraints exerted on maraude volunteers, who, thus considered potential perpetrators of illegal acts – such as aiding illegal entry – have to constantly defend the legality of their action and the legitimacy of their place in the mountains.
28Hence, although the group does not describe it in this way, the humanitarian dimension of risk reduction of the maraude activities is combined with an eminently political dimension. Firstly, through their in-depth understanding of the territory near the border, the volunteers appropriate the mountain space and get to know every path, every crossing point and every landmark. Their presence in this area, usually hidden from outside scrutiny – in the forest, at night – enables them to observe the police forces and reduce their impunity, by passing on their knowledge of the mountain and their practices to other volunteers. Secondly, when they give vulnerable people shelter, “the suffering body is […] removed from biopolitical control” (Fischer 2012), turned away from the violence of the border space and the power of the police. This resistance to the state’s domination of migrants involves a form of reappropriation and regaining of power over the territory.
- 18 The mobile gendarme units had a small and irregular presence that winter, as they were mobilised in (...)
29Checks on the UMMA vehicle with migrants on board remain unusual: they were conducted nineteen times during the 2020–2021 winter season, four times in 2021–2022 and not at all in 2022–2023.18 Despite their relative rarity, these situations of conflict between volunteers and the police – altercations that are often described as violent and distressing by group members – remain central, and are the subject of much discussion within the group.
30Among the maraude volunteers, the UMMA health workers are in a special situation, since the decision to refer migrants encountered in the mountains to hospital or to the Terrasses Solidaires centre for shelter is based on their professional expertise. Their decisions sometimes clash with the police, who may ignore or challenge their diagnosis, giving rise to “struggles over the management of the ‘biolegitimate’ suffering body” (Fischer 2012, p. 490). In the event of a check on the road between Montgenèvre and Briançon, sometimes as part of a police roadblock, the police may oppose the decision to shelter and then arrest the migrants in the UMMA vehicle. They are then taken to the PAF station, and then pushed back to Italy. The police sometimes specify that the emergency services can be summoned if necessary, once they are at the Montgenèvre station.
M, a volunteer nurse with Médecins du Monde, on the arrest of migrants who were being cared for in the UMMA vehicle:
“We told the gendarmes that they didn’t have any papers and they asked us to get the people out of the car. I then emphasised the Médecins du Monde mission and that our first priority was to get people out of the cold, and I highlighted the state of hypothermia and the danger these people were in: they had spent at least 5 hours in the mountains. I also stressed that one of the people in the other car had a sore leg and needed to be examined. In view of these health-based arguments, they asked me for my professional ID card, but I didn’t have it with me, and I showed them my Médecins du Monde mission order. They asked me what I did for a living, and I told them I’m a nurse, and they said I’m not qualified to say those things. […] Meanwhile, the gendarmes were inspecting the car, whistling and laughing. After a while, about 30 minutes, the PAF lorry arrived. The gendarmes’ tone changed and became much more threatening, telling us: ‘If the people aren’t out in 3 minutes, everyone will be taken into police custody, they’ll end up with us anyway, I have clear instructions’.” (Extract from interview, March 2022).
- 19 Médecins du Monde, report 2023.
31The balance of power at the heart of negotiations concerning a person’s vulnerability and the diagnosis made by health workers is decisive for the persons concerned, since the outcome determines whether they will be expelled from French territory. In this respect, the UMMA’s stance is in line with the decision to protect (sanctuariser) care facilities,19 and therefore the unit’s vehicle, despite the opposition and intrusion of the police forces: once someone has been diagnosed as requiring urgent care, the police should not contest this decision and arrest the migrants present in the vehicle. This position in fact draws on the humanitarian argument linked to the risks of the mountains: for Médecins du Monde, a person in the mountains at night without any equipment is by definition vulnerable and requires shelter.
32It is interesting to note that the medical decisions taken by the UMMA health workers are not all equally valid in the eyes of the police, with gender and age relations compounding the conflicts between police and healthcare authorities. Older, more experienced male doctors are more likely to be taken seriously, while younger, female nurses regularly have their health assessments called into question, and have difficulty negotiating with the police, despite their professional expertise and the fact that they follow exactly the same protocol governing the UMMA’s activities.
33As illustrated in the following interview extract, there are also differences in behaviour between the PAF and the mobile gendarmes, with the latter not necessarily aware of how to behave when dealing with volunteers.
B, a volunteer doctor, was confronted by three mobile gendarmes as he tried to provide four migrants with care. He explained:
“So we even started negotiating before we saw them, saying: ‘If there’s any indication for treatment, you have to agree to us putting them in the Médecins du Monde car and taking them down to Briançon.’ So that’s when they asked for my doctor’s card, to make sure I wasn’t talking nonsense, I think, so as soon as they saw my doctor’s card, I think we’d pretty much come to an agreement that if they really had hypothermia, or had a broken hand, we’d put them in the car and take them down. […] So all four of them [the four migrants] sat down [in the Médecins du Monde car], we gave them hot tea and the gendarmes didn’t want us to leave: ‘Wait, no, no, it’s not us who decide, it’s the PAF’. […] I said ‘Now listen, they’re hypothermic, they’re all soaking wet, there’s one who can’t move his wrist, I don’t think we should hang around.’ And there we stayed for a good half hour, I didn’t count but a good half hour, negotiating with the head of the three gendarmes. […] Anyway, finally the PAF car arrived. The man in charge of the five gendarmes got out, and I said to myself, ‘Well, I’ll get out too, we’re not going to let ourselves be intimidated.’ […] The gendarme explained the situation to him, and the PAF officer said ‘But is there a doctor?’ and I said ‘Well, yes, that’s me’. […] And that only took thirty seconds. He said ‘Ah, there’s a doctor! Is there an indication for treatment in hospital? Well, you’re going down to Briançon.’ And he said the only requirement is that a car accompanies you all the way down to the hospital. And he turned around. [...]. We know that we’re on the brink of… misunderstanding. So I knew I had to negotiate. I was sure of my facts from a medical point of view and from then on, I had nothing… Well, I had no other opinion to give, so I didn’t mind negotiating from a medical point of view. It’s not a problem.” (Extract from interview, November 2023)
34To cope with pressure from the police, the volunteer teams have gradually equipped themselves with various resources, such as legal arguments developed with lawyers to support their position, taking a formal mission order with them and wearing a Médecins du Monde-branded gilet. They also conduct annual role-playing exercises to re-enact conflictual situations, and to discuss best practice.
35The space of the mountains and the ability of migrants to circulate within it is thus centred around the opposition between two authorities, medical and police, both of whom claim to give migrants “shelter”, but use the same terminology for two different realities. This rivalry of authorities and the ability to act on the need for care reveals that, through the question of bodies and their vulnerabilities, “it is more than ever the border of the state that is at stake” (Fischer, 2012).
36At the Alpine border, the fight against irregular and illegal migration is reflected in the policy of targeting and expelling illegalised migrant bodies. The colossal resources devoted to this migration control apparatus force migrants to confront the hostile conditions of the mountains to avoid systematic pushbacks and the violation of their rights. The ambivalence between rescue and control persists in the discourse of the administrative authorities, although the stated objective of risk reduction, easily mobilised in this high-mountain environment, does not tally with the facts when we examine the actual conditions in which migrants are granted access to healthcare. The Alpine border is an exhausting and injuring space that increases the vulnerability of people who already carry with them the violent and precarious experience of crossing other borders, resulting in a continuum of physical and psychological trauma.
37The occupation and appropriation of the space by maraude volunteers help to redefine the border and the possibilities of access to French territory for migrants. Respect for the unconditional right to health is central to the conflictual relations between the police and volunteer health workers. The practice of rescue and care, whether via maraude activities in the mountains, or at the Terrasses Solidaires centre in Briançon, is an act of resistance to the biopower that the state claims for itself over the lives of migrants. Through its subversive dimension, the intervention of the maraude group is able to weaken the relations of domination exercised by the state over the illegalised immigrants it seeks to control.
38In the area around Briançon, these struggles over the bodies of migrants temporarily reduce the violence and inequalities produced by borders, with care and reception facilities enabling a relative rest in the migratory journey of migrants if they manage to cross the border. However, beyond Briançon, the migrants assigned to these “border-bodies” (Guénif-Souilamas, 2010) by increasingly restrictive migration policies will carry the border with them, in their bodies and psyches, far beyond the purely geographical border space. This is therefore a brief stage before they reach larger cities, where non-reception policies and poor living conditions have a harmful and lasting impact on the physical and psychological health of migrants (André et al., 2019; Fassin, 2021).