“Health tourism” or “atrocious barbarism”? Contextualizing migrant agency, expertise, and medical humanitarian practice

A Tale of Two Kidneys, On July 24, 2013, Roseline Onoshoagbe Akhalu was celebrating. She had just won her second appeal against deportation to Nigeria by the United Kingdom Border Agency (UKBA). Judge Southern, on behalf of the Upper Tribunal, stated, “the circumstances here were, if not truly unique, so exceptional as to stand out from the ordinary run of cases where a claimant complains of being disadvantaged by a comparative lack of medical care in his or her own country” ([2013] UKUT 400 (IAC) §53). Removal to Nigeria was deemed “disproportionate,” and a result it is now likely that Akhalu will be able to remain permanently in the United Kingdom, and continue her life. The relationships established with her physicians and the “ongoing therapeutic relationships” with National Health Service (NHS) providers were reckoned significant enough that she had a right, under Article Eight of the European Convention on Human Rights (ECHR), to a private life, thus safeguarding her claim to residency and continued medical care (Toal 2014). Akhalu’s victory was a remarkable conclusion to a long sequence of medical and legal ordeals. Akhalu first came to the United Kingdom in 2004 with a financial scholarship for a Masters degree in International Development. She left behind in Nigeria no immediate family; her husband had died of a brain tumor several years earlier, and they were childless. But while undertaking her studies, she was diagnosed with kidney failure. Several years of treatment ensued, concluding, or so she thought with a successful transplant in 2009. But, like many transplant patients, Akhalu is destined for a lifetime of immunosuppressant pharmaceuticals. Whereas she won her appeal to remain in 2012, the UKBA challenged the ruling, and argued that it was not the responsibility of the United Kingdom to provide health care to aliens. Akhalu’s legal team marshaled vital country conditions reports to argue that comparable medical treatment would be difficult to obtain in Nigeria, and beyond the means of a person with such a limited earning capacity, and that removal would constitute a “disproportionate” burden.