Territoires, mobilités et santé : comment composer et penser une offre de soins pour les populations migrantes en situation précaire ?

International audienceThis article deals with health and healthcare access of migrant populations, placing the debate around the point of view of migrants (individuals and family) as well as of professionals working with them. The article questions on the one hand the social determinants of health and the determinants of healthcare access by taking into consideration the set of constraints, incoherencies and resources available for health and healthcare. On the other hand, it shows how healthcare professionals implement new forms of action destined to migrants. In a changing local and national institutional context the issue raised is how to set up actions towards migrants in the domain of health and healthcare. Further, it considers how to ensure that existing structures and organizations are adapted to the situation of a population that is, more than others, likely to remain at the margins of the healthcare system?The article studies the administrative and juridical healthcare access for migrants in France. Two main assessments can be put forward: first of all, the migrants’ pathways to healthcare are characterized by long delays before accessing primary care; second, healthcare pathways appear as “coordinated” (between emergency healthcare and common access) only when residential and administrative situations are solved and stable. Our global observations are based on fieldwork in France; they show that there are very heterogeneous ways to access healthcare for newly arrived migrants, and generally that they stay longer than other precarious populations in the circuit of emergency humanitarian health. We also notice that the difficulties in accessing healthcare for migrants are only a part of the difficulties experienced in migratory experience. We attempt to describe types of daily barriers (administrative situations, difficulties in accessing rights, negative representations of migrants within society and/or social and sanitary services, language) and to underline the necessity of taking into account the socio-spatial dimensions of healthcare access in everyday life.The article includes a methodological section explaining the fieldwork (interviews with patients and professionals) and describing the content of the interview grid (see figure 1.)The patients’ points of view are described through the use of “synthetic biographies”. These biographies underline the everyday spatial constraint obliging individuals to develop tactics and strategies to move to the city (and between cities) in order to access different services.The professionals’ points of view are analyzed in regard to their professional practices, and the way they use some “tinkering” to favor new forms of actions targeting migrants. We can observe in the fieldwork the multiplication of “go towards” practices, usually used in the medico-social field (and generally to set up actions meant to “go towards” individuals identified as precarious –in the domain of addictions or HIV-AIDS). These actions include a spatial register: actions tend to “go towards” people living in the street or in squats. These professional practices lead to a type of medicine that is institutionally framed but concern very specific professional acts. We thus analyze the way this tinkering becomes possible and how it appears in the interviews we have conducted with general practitioners.The discussion and conclusion aim at considering the different spatial inscriptions of these forms of actions in public health. We have also studied the situation of migrants in precarious situations: on the one hand they endure the deleterious effects of their living conditions, but they can also develop very original spatial knowledge and multi-situated sociability that can be analyzed as ““mobility know-how”.Cet article aborde les enjeux de santé relatifs aux populations migrantes primo-arrivantes en les interrogeant du point de vue de l’expérience des individus et des professionnels qui travaillent à leur contact. D’un côté, il interroge les déterminants sociaux de la santé et de l’accès aux soins tels qu’ils se présentant pour les migrants, en prenant en compte l’ensemble des contraintes, des ruptures, mais aussi des ressources mobilisables pour la santé et les soins. D’un autre côté, l’article interroge la façon dont les professionnels de la santé mettent en place des actions à l’égard des migrants, dans un contexte institutionnel national et local changeant : comment mettre en place des actions à destination de ces publics ? Comment faire en sorte que les organismes et structures existantes s’adaptent aux situations des populations les plus susceptibles de rester en marge du système de santé