Compassion, Crossings, and Refugees: A Conversation with Dr. Alexander van Tulleken

Dr. Alexander van Tulleken is the Helen Hamlyn Senior Fellow at Fordham University’s Institute of International Humanitarian Affairs. He has worked with Doctors of the World, Merlin, and the World Health Organization on various humanitarian crises around the world. Dr. van Tulleken and his twin brother, Chris, have produced several public health-related television series and, most recently, a BBC documentary about the medical problems Middle Eastern refugees face called Frontline Doctors: Winter Migrant Crisis.

Dr. van Tulleken recently spoke with Copy Chief and Executive Editor Katherine Labonte about his work in humanitarian affairs and the ongoing refugee crisis in Europe.

Do you want to give me a little background on yourself?

Well, I trained as a physician. I trained at Oxford in the UK, qualified in 2002, and spent the next sort of 10 years or so working in the UK on my residency and internship and so on, and also working overseas in humanitarian crises, particularly with Doctors of the World, who were a large healthcare NGO who work in emergencies. And because of my background working in remote or austere environments, I’d also been lucky to make two television programs with my twin brother who’s also a physician.

So I’d been working in humanitarian affairs and medicine and making television programs of one kind or another for 10 years and then was able to merge those interests with this documentary, so this was a particularly kind of nice film to be able to make because it was a film about an area which I thought I understood well.

Can you tell me more about the documentary?

So the idea was to follow the journey of migrants through Europe from their arrival in Greece, in Lesbos, which is the place where more than half of the European arrivals land, to see what their experience of the journey was and to see where they ended up. That’s interesting in a couple of ways. Firstly, because we rarely see people on the journey. I mean, certainly working in refugee camps and with displaced people through my career I realized I never actually watched people on the journey — you just don’t get to do that. So, we were looking at their health problems, and what was striking was how much people wanted to keep moving and how few opportunities there were to provide them with health care over that time.

And so the premise of the program was that my brother and I would set out and start together in Lesbos. He actually spent time in the lifeboats with effectively with the volunteer coast guard, and I mean it’s absolutely extraordinary — he was out with the Spanish group of lifeguards called Proactiva who were meant to be rescuing people, but he could see boats just across the sort of invisible boundary on the GPS of international waters and therefore they were not allowed to rescue them and bring them to Greece. You had to be in Greek waters before you qualified to be rescued and even then, the boat had to be in dire straits before they were allowed to help or else they would be accused of human trafficking. So, the very very first things we saw before people actually set foot on European soil was this weird, weird, weird issue around assisting people on their journeys where if you try and help people who are in the business of being refugees, of fleeing, you run the risk of being accused of human trafficking.

And I think that issue which you saw in the boats was just echoed through the whole thing — this tension between if you make it easier for the refugees, you run the risk of more people making the journey. But does that encourage more migration than Europe would want? Also if you make things easier for the refugees you run the risk of human trafficking. Where do you draw the lines to those things? Personally, I think if you look at what people are prepared to do with almost no assistance, what we’re talking about is a million people are going to arrive — at least a million people are going to arrive in Europe this year from Syria, Afghanistan, Iraq, and probably about 6 other countries — and they will all be prepared to endure extreme hardship, and if the journey is made easier for them, then only more people will leave and not be left to die.

What do you think has caused this issue with this difficulty between human trafficking and helping those in dire straits?

I think the reason that it’s so difficult is that it is a genuine mess, and the refugees are not a monolith. So the refugees are an extremely diverse group of people. And there are very few ways of describing them that capture all of them, if you’d like. So, some of them are economic migrants. I mean, I interviewed young men in Athens in the town square who had been there for months, and most of them were from Tunisia or Morocco and those are not countries that are at war. Now, it isn’t easy being a young unemployed man in Tunisia. There are not many opportunities for you, your human rights, the government is committing human rights abuses, and there are all kinds of problems. Still, the refugee convention was not really designed for them, and they probably should not be granted refugee status, or at least, they’re pretty far down the list of needy people.

On the other hand, speaking to them for me was extremely moving, maybe as much as any other group. They’re a group of people I related to — they weren’t much younger than me, and seeing a group of young men who just wanted to get themselves an opportunity and find a life and earn a living. And some of them said, “I want to go to London because in London you can drink and party a little bit more.” And that’s the stuff that doesn’t make it easier to raise money for an NGO. Those aren’t the stories we read in the newspaper, not in the left-wing press.

And yet, in a way, you think, “How relatable, to be a young man, just wanting to have a drink and a good time, an opportunity to be free and earn some money.” That, to me, in a way, the impossibility of those things is just as punishing as many of the other refugees’ circumstances. And indeed, yeah, I guess our insistence that that freedom be denied to those people felt like another injustice, I suppose.

Right, it’s like you’re almost creating a spectrum of need.

Right, or like there’s a hierarchy. Because there is a range of need. Clearly, there were people whose houses were being bombed, and these were just guys who wanted to get a better paying job. What you were creating was a hierarchy of deservingness. So there’s this very strange situation where the worst things were in your home country, with Syria being the worst — depending on who you are, Syria’s pretty bad at the moment. That was an advantage. Once you got to Europe, it was great being Syrian because you would probably get refugee status. You’d be granted asylum if you could prove you were Syrian. And that’s a pretty strange thing.

So, the Syrians could get in the shelters and get asylum. And it wasn’t great for the Syrians. But you know, the young Tunisian men were being held down by the police every other night, and just living in the square, and were eventually all going to have to go home and figure out another way. So, they were stuck. And there were some very sad people who were totally stuck. I mean, I interviewed a 50 year-old Pakistani man in Athens. And where was he going to go? He was never going to be granted asylum. We’re not taking refugees from Pakistan. So in a way, he was a particularly sad case. Although the things they’d endured in Syria were worse than what he endured in Pakistan.

So, I was left with this. I don’t know if I can capture it. I tried to write about it in a blog post that I wrote as well. I think it’s true in America as well, but particularly if you’re English, we in the West have benefitted enormously from global inequality. Not just in the last few years and at the moment, but overall for centuries. We have extracted wealth from around the world. And we have made a mess of lots of parts of the world, and I mean, at the moment we’re bombing Syria, but in the long term, the consequences of our indulgences of Assad’s destabilization of an area that allows ISIS to flourish, all of these things, you had a sense of something like a reckoning, of people from the global South whether they didn’t have jobs, or they were being bombed, or they wanted more freedom. Those were things they felt they could demand from the West because the West was in some way responsible for their situation.

And I found it very hard to get to a conclusion that didn’t involve letting very large numbers of refugees into Europe. That was where I landed in terms of what I think should happen is that we should let large amounts of people in, and that’s not a very popular position.

Absolutely. You also mentioned in a recent interview that you felt a frustration with a lack of large-scale government intervention. Why do you think we’ve seen that?

In some places there is large government intervention. For instance, when you go to Germany, the camps in Germany are excellent. There are better camps than I’ve seen anywhere else in the world. And although no one wants to live in a camp and all camps are hell, these camps are at least relatively a comfortable safe kind of hell. The camps in France are probably the example of the thing we’re talking about, where the government, the big UN agencies, the big NGOs, very few of them were doing very much. And let me see if I can explain it.

The French government has built large numbers of high quality shelters and in doing that, they’ve revealed the essential sort of contradiction of humanitarian aid which is you either deliver the kind of aid that contains people and governs their lives, you put them in a well-run camp. Imagine what you would want if you had your children in a refugee camp. You would want it to be well-lit, and you would want it to be safe, which would mean you wouldn’t want a steady stream of men coming in and out, you would want to be protected from sexual violence, and other kinds of violence, and your children all the same. You would need everyone to be registered, everyone to have an ID card and entry and exit to be controlled. And those are things that aren’t just about government control and kind of nastiness. Those are about running a safe space for refugees, many of whom are women and children and vulnerable men. And so if you do that, the problem with the French state doing that is that it restricts people’s freedom. And all those people in those camps in France, they don’t want to be in France. They want to leave and go to England or Sweden or somewhere other than where they are. None of them want to apply for asylum in France. And for good reasons.

I read a lot of this in the right-wing press. People say, “Oh why don’t you just stay in France, you know what’s the problem with staying in France?” Well, if you’re a Syrian, like the Syrian doctor I interviewed — he grew up reading Shakespeare and Dickens, he speaks fluent English, he took English medical exams, he supports an English football team, he knows the rules of cricket. I mean, this is a guy who knows something about English culture. And in the same way that you as an American refugee would probably want to be in Canada than, I don’t know, Ulan Bator, he would rather be a refugee in England than in France. And he would be a more productive person. In France, he would have to learn good enough French to be a doctor in France, which would take three, four years. I mean it would be a hell of a thing.

So, the problem is that the French state — much as I dislike the way the French state has handled this — their basic argument of going, “if you want stuff from us, you have to apply for refugee status. You can’t have French healthcare and French schooling and illegally trying to make your way out of France. And you can’t run an illegal business, and all these cash transactions and these shanty towns in France. You either sign up through our process, or you can bugger off.” And that isn’t nice, but the business of being a modern government is that everyone has to be registered. The American government requires you to have some sort of ID, and you have to sign up and they like to know who you are and where you are and what you’re up to. And the French government have said that’s what they want from the refugees as well.

So it’s not like the French government isn’t doing anything. It’s that the thing they’re doing isn’t what the refugees want. What the refugees want is unlimited, high quality services, and the right to try and get on a truck to England, and with the French government, you can’t do those things, and it’s all long winded and isn’t going to make it into the arsenal, but does that all make sense?

No, it does, I agree. Of course they have a right to go to England, and I think a lot of it goes back to human dignity, as well.

And it’s difficult because I understand people’s nervousness about the large number of refugees coming in. My personal psychological makeup is that I’m not afraid of refugees. My identity has got very little to do with being English, and I don’t have a lot of faith in that so I’m not worried about changes in English culture. I’m not worried about England becoming a more diverse place, and I’m not worried about terrorists. It’s just, I’m not made up that way, but I can see that lots of people are.

It’s very difficult because, if you’re in France, and you get to England and the English go, “What are you doing?” and you say, “I’m fleeing persecution and I’m applying for asylum.” And they say, “Okay what was the last country you were in?” and you say, “France” they can say, “Hang on a minute, you’re not fleeing persecution, you just want to get to the very best place.” Now, you could understand the argument that goes, “Well, hang on a second, there’s loads of people in France who’d like to move to England, and we don’t let all of them in. There are loads of Americans who want to move to Canada and vice versa, and we’ve got borders and passports, for a reason so, sorry, you can’t do that.”

Now I think that it’s much better off to have a system where the refugees can go where they want because in the end, what’s good is if England has a refugee who’s happy to be in England, and France doesn’t have a refugee who’s unhappy to be in France. And if you force them to stay in France, it’s crap for everybody. England misses out and France misses out. And that person misses out. That’s my logic, but I’m not sure I’m right if you know what I mean, or at least I wouldn’t be very confident in persuading anybody else.

No, that makes sense, absolutely. Do you think the political climate of Europe has any effect on the wide range of how different European countries are treating refugees. I mean, I think we’ve seen a rise in far-right governments, especially in Central and Eastern Europe and they tend to be, from what I can tell, more hostile to refugees. Do you see a correlation like that?

Well I think it’s not just a cause and effect. It’s a reinforcing loop. I mean, the number of refugees coming in has definitely increased the influence of far-right politicians in Europe. But the increase in far-right politicians has also affected not just the number of refugees coming in, but also the way they are treated. And the worse they’re treated, the more you get scenes of agitation, violence and disruption, all of which play into the right-wing rhetoric that says that refugees are scum and should be sent home. So you’ve got this kind of, you know, it’s a vicious cycle.

Right, and it’s a bit of a chicken or an egg thing, like one fuels the other and vice versa. It’s becoming so messy at this point.

Martin Amos wrote a very good story in the New Yorker recently. I mean, Martin Amos is a pretty obnoxious guy, but he had a lovely way of talking about it, and the last line of the story captured it rather nicely. It was a short story called Oktober and what he said was,

When I closed my eyes, I was met by the usual sights—an abstract battlefield or dismantled fairground at dusk, flowers in monochrome, figures cut out of limp white paper…And so many possible futures were queuing up and jockeying to be born. [So he’s talking about Europe at the current moment]…And, in time, one or other of them would go thundering clear of the rest. And they were coming here, the refugees, in the eye of a geohistorical convergence—themselves and their exodus on the one hand, and, on the other, Al Qaeda and Al Shabaab and Boko Haram and the Taliban and Sinai Province and ISIS.

“And even now it was as if a tectonic force had taken hold of Europe and, using its fingernails, had lifted it up and tilted it, politically, causing a heavy mudslide in the direction of old illusions, old dreams of purity and cruelty. And that force would get heavier still, much heavier, immediately and irreversibly, after the first incidence of takfir. And then Europe—that by now famously unrobust confederation—would, in fact, meet its ‘historic test.’”

So really lovely, kind of weird story. I mean, I almost gave up reading, I was getting a bit bored. And then it lands at this moment, and you get goosebumps going, “Oh fuck, it’s all happening again. We’re going to start, but it won’t be the Jews this time, it’ll be the Muslims, but probably the Muslims and the Jews, but everyone else as well.” He’s a very unusual writer and quite Islamophobic and quite odd. So yeah, I have a sense that . . . my personal reaction is to try and treat people with . . . there’s this idea that, you’re probably aware of it, in most theories of justice that say, you know about the veil of ignorance? That basic idea of saying, “You know, how would you want the world to be arranged not knowing who you would want to be?” And I think my inclination is to say that we should have relatively open borders, and that’s good.

And I think most economists, the majority of economists would say, “Yeah yeah yeah, free free free, let people move around,” but the sense I have is that Germany had a bit of a go at that, and it has been catastrophic. I mean, it makes no difference, a million people to Germany makes no difference at all. It’s not a large number of people, the German economy will cope it’s not a big deal. And indeed, Europe could easily do well out of this refugee crisis. We’re getting the best of Syria. You know, if you think of who is leaving Syria, Germany is smart because they took the first million. The first million people out of Syria are the people who are, you know, rich enough, smart enough, educated enough to get going. The last person out of Syria is probably going to be a more difficult proposition, and so but even with that, Angela Merkel has suffered enormously as a result of it. And I just have a feeling that in times of crisis the world moves to the right. I suppose, I mean is that what history teaches us? You’re probably as good of a judge of that as me. I don’t know.

That does make sense. I think with the, not so much the economic crisis, but the economic issues that Europe has been having coupled with this influx of migrants, I think it’s a natural reaction to jump to the right, as well. On that note, what do you think of Greece’s recent decision to begin deporting migrants?

I think it is disgusting. The best I can hope is that the people who made that decision have never met or thought about refugees and that they are simply vicious pragmatists. But if you had met people coming off those boats and made that decision, that would make you a psychopath. It is an unconscionably appalling thing to do and it is a disgustingly . . . I mean, I cannot imagine the pragmatic business of doing that to those people. I don’t know who you would have to be to line them up and put them on those boats.

Right, and a lot of the rationale is they’re saying that they can go back to Syria and make a legitimate claim for asylum. Well, the government of Syria is collapsing, so how are they supposed to, you know, queue up and apply to migrate?

Look, the complexity of the crisis … this is why I end up feeling in fairly crap rules of thumb like, “Hey, we should just let everyone in,” because if you get into the long grass it does become quite complicated. The calls on David Cameron to take the people in the camps from France to England are …  he’s done a bit of slight offhand and said, “Oh no we’re going to take the more needy people from Jordan because those are the people who are more vulnerable.” Now, I’m not sure that’s the case, but you can sort of understand the logic of that argument being, “well these people are in a really terrible situation — they’re not in France, they’re in Jordan.” In the end, it’s a disingenuous argument, but it is quite difficult to know at what point to start helping people.

In the end, I think allowing the refugees to choose where they want to go is a good idea, and in the long term, all this must make you think is the desperate inequality of the world will keep sending people, but there is no possibility that people will stop coming. And they will die in the thousands as they already have done to try and get to Europe, but they will keep coming. And so, it must force a deep interrogation of our culture and our way of life that is supported by this kind of inequality that allows people to be in such desperate circumstances that they will get onto a fairly dangerous boat and try and cross the Mediterranean or hike in some cases virtually barefoot across the mountains to try and get to Europe.

I mean, we met an Afghan lady whose feet were swollen and I asked, “Well, why are your feet swollen?” and she said, “Well, I’ve walked from Afghanistan.” And you just go, “You don’t need a doctor to tell you that your feet are going to swell if you walk from Afghanistan.” What’s the treatment? Stop walking the way from Afghanistan, you know. And if that’s the level of desire to get out of Afghanistan, we have to wonder what situation we’ve created in those countries. I suppose and it sounds, and perhaps you’re just being polite, but it sounds as though your political sympathies are fairly close to mine.

Yeah [laughs]

And perhaps I’m just being naive but what are you? A political scientist or…?

I’m a political science and Middle East studies double major with a minor in theology.

So you probably have a much more, in terms of like, the ethics, the regional complexity, and the politics, you probably have a much more sophisticated view than I do on all of this stuff. I mean, remember as well, I’m a doctor, I’m not … the whole documentary cites that all of these questions, by going let’s just ask about the medicine. And that’s what humanitarianism does in general, frequently goes alright this is all too much of a mess let’s ask about health.

Yes and even, I spent a year in London last year at the London School of Economics and I traveled extensively and I have a very vivid memory of being in Calais at the port and I think we were passing by a significant border crossing for migrants and we saw, I remember looking out the window and I saw people literally running for their lives to the port trying to get on a truck or a boat to England and it has just stuck with me ever since. It’s a very striking image. And that’s only scratching the surface, but I don’t understand how you can see things like that and not be bothered.

And that in a way, like if you’ve seen that with your own eyes, then there isn’t much more to tell you to be honest. To me, it felt like all those dystopian future movies, whether it’s Babylon or whether it’s that Damon one with the robots or something, I can’t remember, but do you know the kind of extreme bladerunner, like the poor people live underground and the rich people live in something that orbits the earth, do you know that? I can’t remember but it’s a whole genre. And when you saw the gleaming white fences in Calais, and the westerners on the one side and some sort of inaccessible West on the one side. When you were there, had all of the fences gone up yet? All of those roads in Calais now are surrounded by fences.

No, I left last June. I think that was really before it hit its peak.

If you imagine all those roads you drove down, for miles, outside of Calais, surrounded by 20 foot high white fences with policemen walking all along them. It is honestly a vision of the future. It is unbelievable. And I think I musn’t make the mistake of thinking it’s not sustainable. We can live in a world of extreme inequality and violence and horribleness. In the end, we all do worse because of that. I believe it’s not a zero-sum game, and we’ll all thrive if we’re nice to refugees, but I’m not sure enough people agree.

No, that makes sense. For one final question, to hopefully end on a higher note. Where do you think we go from here? I mean, how do we look at this crisis, how do we respond to it? What do we do?

That is the question that forces itself upon you every single step of the way of looking at this crisis: What should we do? And almost everything you say should be done has a good and a bad outcome. If you say, “Take all the refugees from Calais,” that does bring more people to Calais, which creates more problems with French, which creates more problems. If you say, “Build a safe, clean, high quality camp,” that contains people and is bad for the refugees’ freedom. If you say, “Help people come across the ocean to Greece,” it propels them on a journey that many of them will eventually fail at. So, rescuing all these people and helping them through Lesbos got a lot of people to the Macedonian border in the freezing cold where they were turned away.

So in the end, I think what should be done . . . either there are moments of human kindness and grace where you can say, “Look whatever the broader circumstances, a bed for the night is important, a hot meal, a hug, someone with some compassion for you, even if they can’t help you.” I think those things make a difference, and we should do more of that. And I think that would go a long way to put up more productive conversations about the long term future of refugees in Europe. I personally think we should be allowing millions of people into Europe. I think we just have to sign up for that and make it work. There is nothing else that will do. And I think we need to . . . look, now I’m just a doctor talking about foreign policy, and I don’t really have a fucking clue how you — I don’t know.

I think what is important to remember is that almost no one wants to be in Europe. People want to be in a peaceful Somalia, or a peaceful Iraq. You speak to your Somali taxi driver in New York, and they still talk about Somalia as home and they want to go back. Refugee communities dream of going home, and so this fear that they’ll all come over and take over England and that we’re all going to be speaking Arabic under Shari’a law is total nonsense. Almost all these people will be productive contributors to our economies for a brief period of time and will go home when the war ends.

What do you think should be done, I mean you’ve been to Europe, you’ve studied at LSE, you’re at Fordham, you’re doing your double major, what should be done?

It’s just such a mess. It’s so hard to look at it and come up with …  no matter what you do, there is an upside and a downside to each solution, and the problem is that when you’re trying to think of what to do with the migrants — and I hate to lump them all together into one category — but I think you’re still alleviating the symptoms of a much larger problem.

The problem goes back to the absolute mess that I think the Middle East is right now, which has caused millions of people to flee and we have to look at it and go, “Well why are they fleeing?” Like you even said, they still want to go back home. It’s not like they really want to be in Europe. They had to leave because they’re being bombed. Well, why are they being bombed? We need to both alleviate the symptoms of the problem and solve the problem itself, which is a much larger issue.

And that may not be . . . I think very few people agree on what the actual problem is. I think very few people agree on what the actual solution would be and the solutions, as you say, create more problems, and I’m left going, “I’m not sure …” I don’t even quite know — you say “our” as if I’ve got any stake in it — but at least the government I elected, what should they be doing? I don’t know, trying not to be such a horrible group of people. If you’re bombing a country, you should let the refugees in.

There are so many things at stake, so many causes, smaller problems stemming from that. I agree with you though about not being such a horrible person.

Something like that. And I thought I knew something about humanitarian assistance and something about forced migration, and I was shocked every step of the way with this film.