We demand obligatory sensitisation with regard to structures critical of racism. We demand obligatory sensitisation with regard to structures critical of racism.

The Bundesfachnetz Gesundheit und Rassismus was founded through an open letter published by our working group. The incentive was the decision of the Federal Cabinet Committee against the Right (Bundeskabinettsausschusses gegen Rechts), which made one billion euros available in 2020 to have anti-racist measures implemented in the Federal Republic of Germany. We noticed that the measures that had been decided on did not even touch the health system. We then got to know each other during a lecture by Amma Yeboah on the topic of mental health in correlation with racism and experiences of discrimination and founded this working group. Gradually, the Federal Network on Health and Racism (Bundesfachnetz Gesundheit und Rassismus) emerged from this. We all bring different perspectives and have different points of contact with the health system. Some of us work in it and experience discrimination there as migrant people. Some of us are simply users of the health system and depend on its services.

2020, when the Black Lives Matter movement became very big in Germany, was an important time for me. There was something very empowering about meeting regularly in a FLINTA (Women, Lesbian, Inter*, Trans*, Agender) BIPoC (Black, Indigenous, People of Colour) group, a majority Black group, and working together on these issues. It made me feel empowered and powerful at a time when you feel very helpless and very powerless in the face of what is happening in society.

I have a legal background and have always been active in political activism. In the Bundesfachnetz, I discovered for myself the chance to do something really tangible. My mother is a headscarf-wearing woman and a Muslim, and in my childhood and youth I quickly realised how difficult it is to find one‘s way in the health sector. Going to the doctor is not always easy and you really have to choose doctors who understand you, who are accessible, also in terms of language, who do not work with prejudices and who do not use your cultural background as an excuse for a diagnosis. I think many people who are racialised have had such experiences. When I found out about Bundesfachnetz, I knew I definitely wanted to be part of it.

Our initiative is a majority Black initiative. We are an initiative for and by BIPoCs and are also a FLINTA initiative. Intersectional work is our principle. We are particularly committed to BIPoC FLINTA people, because they experience a very specific violence of racism in the health system, but also patriarchy in general. We want to counteract this and make it visible.

It is a very special way of working because we are also a safe place. This means that our own health, our mental health and our well-being are of great importance to us. We give a lot of space to our emotionality and our interaction with each other as a community, and we are compassionate and empathetic with each other. I haven’t experienced that from other organisations or institutions where I have worked before.

What is important for us is that our priority is always how we are doing and in the second place what still needs to be done. We prioritise our own well-being and we only go into collaborations and requests where we also get something back. So we don‘t just share our resources, but in the sense of power sharing we also want to get something in return.

I believe that we take great care of each other as people. That is one of the strengths of our group. What our initiative as a national association does very well is to connect the different actors. That we connect all the actors nationwide who are affected by racism and are somehow active in the health sector and make them known to each other.

We have prepared concrete demands for this conversation that we would like to share. It starts with the lack of or limited access to health services for people who do not have an official residence status. We demand that statutory health insurance also exists for refugees with non-official residence status, so that they are allowed and able to receive these benefits. In addition, we demand the introduction of extended confidentiality agreements also for social welfare offices for people who receive health benefits under the Asylum Seekers‘ Benefits Act (Asylbewerberleistungsgesetz). Many people are not aware that many people who have no official status cannot go to the doctor. Even if it is an emergency, there is always the fear that they will be deported.

Complementary to the point of extended confidentiality, it is very important to decriminalise medical practices that offer services to people without official residence status and to people who have no health insurance at all.

We would like to point out that especially non-white women are exposed to violent treatment. They often lack the possibility to be accompanied by a BIPoC midwife or BIPoC gynaecologist.

We demand official contact points for FLINTA persons for counselling on pregnancy, abortions, contraceptive methods that are not church-run. We need to include all FLINTA persons and offer counselling outside of binary ideas. We need more racism-critical therapy and racism-sensitive therapists in the field of psychotherapy.

We demand an official contact point or ombudsman‘s office for cases of racist discrimination, which can be reported and which will also be dealt with, in all institutions such as health insurance companies, in clinics, at universities, anti-discrimination bodies in chambers of doctors, chambers of psychotherapists. These should then be staffed by people who think critically of racism and bring critical approaches to racism. We need acute contact points, counselling centres, anti-discrimination centres that take immediate action and offer psychosocial counselling as a kind of immediate help for those affected themselves. These contact points are also important to support in monitoring discrimination. In Germany we have the problem that there are very few studies, very few general facts and figures on the subject. This makes it difficult to argue at a political level and to demand structural changes if we have no basis on which to base our arguments.

Medical studies need both a reform of the content and a reform of the access possibilities. Who studies medicine in the first place? And why are there certain groups of people who get in? Of course, in general, every person who is qualified should be allowed to complete this training, this course of study. However, it is quite clear that too few Black people, Indigenous people and People of Colour can find themselves in these courses of study. There are many levels that make access to these courses more difficult. We would like to start there and begin to raise awareness of racism-critical issues in education and studies.

In the context of the university, we encounter classism when we look at who occupies which positions. Who is in leadership positions? Who are the people lecturing? Of course, they also teach from their perspective. And the fact that these higher positions are held by a certain group of people, and very often simply by a certain class, is already evident in the course of study, who the students are, from which social class they come. This has a lot to do with the fact that many students, for example, cannot afford to study, simply because of the cost of materials and working hours, which then are of course not available to finance their own cost of living. Especially for people with a history of flight or people from working-class families who do not come from academic circles, this entry is much more difficult – keyword intersectionality.

At the same time, I would wish for more options for scholarships, especially for racialised people. And then the question is, how do certain groups of people get the information that there is the possibility to get financial help? Of course, this requires a political focus and the will to make funds available. One of our concrete demands is also that we see more people with foreign qualifications in this study and training. The degrees of many people from the Global South who have studied there are not recognised, or not quickly enough. We definitely need more voices from the Global South and their knowledge.

On the question of who is in medical school and who is in medical education or working in nursing, we need to dive deeper. We definitely see a difference there, because there are many people with a migration background working in nursing. We are in a partial dependency with each other, because especially people with refugee experience who immigrate to Germany and are looking for professions and are supported by the respective offices, for example, are gladly put into nursing professions. There is a great need for them, and for potential employees these professions of course mean security. You can stay in this profession, there are always people needed. It gives you financial security, also security for the future. You will get a pension one day. But it is important that we break this up: Who do we advise to go into care? Who do we see there? And then when it comes to academisation, who don’t we see? Who are we not promoting or supporting?

It is important that we also work with representation and empower people, and give them the opportunity to do further training so that they don’t remain in nursing professions if they are overqualified for it.

This also continues across generations. If you see in your family, okay, this is what seems to be achieveable, then of course it‘s hard to think beyond that and go to university. Also the income, the wealth, you pass on to your children and their children. If this cycle is not broken, then of course you only see yourself in certain professions.

It is definitely important to us that the degree programmes in general need to be reformed, because many curricula are still very informed by Western thought and colonial practices. Of course, this also has an impact on medical practice. It‘s about Eurocentric literature, studies and research material, but also about who imparts what knowledge. This also influences why certain knowledge is not questioned, why certain knowledge is left out. In the US, there is a lot of research on the topic of health and racism and we observe that this is infrequently included in medical practice. Often there is no critical examination of certain biologistic assumptions that are still being taught and are actually still present in curricula.

One example was very present on social media for a while. One person showed how skin diseases look different on different skin types. Dermatology often works with white skin as the standard, which is why diseases are not detected early and certain symptoms are not properly attributed. There is simply no interest in starting with people who do not correspond to this white majority society. Similarly, in medicine, the male body has been assumed as standard in research and drug development, which has harmful effects on the female body.

We have other concrete demands about what needs to change in the health system. We demand obligatory sensitisation with regard to structures critical of racism, especially for medical staff. And this concerns every area that we can imagine, with which we as users have contact, be it with the family doctor or the therapist, who then does not include experiences of racism in the therapy or does not take them seriously. We demand state subsidies for projects run by BIPoCs that do this educational work in institutions. This must be firmly established, that these projects are prioritised in receiving money.

One ideal that we have is to create a nationwide database that is available online, in which racism-critical doctors, medical professionals and experts of colour can be found. However, we are currently extremely critical of such a database, as we fear that such publications could also provide a basis for right-wing violence, such as NSU 2.0.

But our goal is to be able to build up and establish something like this and to be able to do it in a protected way. It is important that all these services are not only available in the typical conurbations, such as Berlin, Hamburg, Cologne, etc., but also in rural areas for people who do not have access to them and who are denied access because of discrimination.

What work should be done by others?

First of all, it is important for us that other parts of society are sensitised to the fact that structural racism really affects every structure of society and thus also the health system. We often have the feeling that this first important step is not taken. It is important that other groups who are also affected by other forms of discrimination, for example, also raise awareness. Because just because I have this one experience of discrimination doesn‘t mean that I know what it means to have another experience of discrimination or that I can‘t reproduce it. This is where we would like to see more sensitivity and empathy.

In the second step, it is very important that demands are also made and supported by the white majority society. We have experienced that white institutions or white individuals are more likely to be addressed and taken more seriously when problem areas are named. Then it is very important on a structural level that resources are made available for this work and that funds flow from white institutions into BIPoC and FLINTA structures so that they are supported. We demand more visibility of BIPoC voices and BIPoC experiences, especially the inclusion of non-Eurocentric scientific work.

We have to make this appeal very loudly, that also non-affected people have to represent this demand and do this work as well and also have to enforce within state projects and on the state-funded level that this work is seen. It is important that this is not exclusively political activist work in a social niche, but that it is recognized how important this is and that it affects us all. That we as a collective, we as a society have to work on it. We have to work very hard with data collection – keyword Afrocensus. The Afrocensus was the first nationwide survey of Black people in the EU on how they are discriminated against, and all sectors of society were listed. This is enormously important work, the data of which we can now refer to and on which we can base our demands.