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Presentation for the Research Network for Refugee Health Tromsø University ANNABELLE BÖTTCHER 5.2.2018 CENTER FOR MELLEMOSTLER STUDIER INSTITUTE FOR HISTORIE SYDDANSK UNIVERSITET ODENSE BOTTCHER@SDU.DK 1

Ø What happens, when Muslim actors (patients/physicians/nurses) from the Middle East interact with the Danish health system? Ø What role does Islamic/Middle Eastern culture/religion play? Ø What concepts about body and space might be relevant during these encounters (clinic/hospital)? Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 2

Dietrich Jung, CCMES, History, SDU SDU Morten Sodemann/Dorthe Nielsen, Global Health/MigrantClinic, SDU Charité Universitätsmedizin, Berlin EXTERNAL Institute for Islamic Studies, Free University, Berlin Muslim scholars OTHERS Muslim health staff Association of Syrian Doctors in Germany Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 3

In-depth interviews (interview guideline) with 50-100 male and female MEM patients & experts (medical staff & religious authorities) Interviews last 2-5 hours, Arabic, English, French; Consulting printed sources & social media (Facebook etc.) Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 4

Ø Find out, which interactions go smoothly and where tensions/challenges exist Ø Contribute to successful patient & health staff diversity management by translating the findings into tools Ø Increase patient and health staff satisfaction Ø Save money and time Ø Increase interdisciplinary collaboration between health studies and humanities/ Middle Eastern Studies Ø Publish and contribute to scientific debate Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 6

Influence of MEM culture and religion on Danish/Scandinavian health care increases, because of the 1. increase in number of MEM health actors in Denmark/Scandinavia 2. Strong social, economic, and political ties with the Middle East region 3. Strong affinity of this network of health actors for portable communication devices (smart phones, tabletts, laptops) Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 7

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6. First Results MEM concepts of body and space management ARE relevant for the Danish/Scandinavian/ European health landscape 1. Space Management : Ø Gender mixing +2(Arab. ikhtilât) Ø Privacy of mixed gender, gender mixing 2 (Arab. khalwa) 2. Body Management: Ø Covering of private body parts by male/females in front of strangers (Arab. awra / aura) Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 10

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A „Muslim“ is born a Muslim to a Muslim father or Ø converted to Islam Different degrees of following Islamic dogma (prayer, Ø fasting etc.) / change over time Different degrees of influence of (Muslim) Middle Eastern Ø culture / change over time „Muslim-ness“ is not the only factor defining identity and Ø influencing interactions in the Danish health system. Other factors are gender, age, social class, education etc. Ø Middle Eastern societies, like the Syrian, and Iraqi, are not Ø closed rooms with a consens about religion and culture. Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 10

„Muslim“ women in Denmark Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 14

„Muslim“ men in Denmark 15 Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018

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Islam is the 2nd biggest religion in Denmark (4%) In 2017; among the eight major countries of origin of immigrants to Denmark, five have a Muslim majority population: Syria (33.616) Turkey (32.606) Iraq (21.383), Bosnia and Herzegovia (17.104) and Iran (15.970) Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 14

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Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 16

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Interplay between Space visibility in space by Management others, number of people present, gender and family relation in Middle Eastern Muslim Culture in Boundaries not static, Denmark shifting 19

PROBLEMATIC in Middle Eastern Muslim culture : gender- mixing of 2 non-related, male & female, individuals in closed space Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 27

Ø Taking another person along as a chaperone is Strategies vital pillar of Muslim of Space space-management. Management Ø Often a husband, son or female relative. in Ø Rules are clear, but a Middle Eastern Muslim very widely interpreted. Culture in Denmark Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 30

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UNPROBLEMATIC gender-mixing of 3+ non-related male & female in closed space Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 32

Woman with a chaperone (mahram) in a clinic in Lebanon/Syria/Tur key Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 31

UNPROBLEMATIC gender-mixing of 3+ non-related male & female in closed space Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 28

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Ø As a rule most Muslim women are aware of the gender-mixing with one unrelated man alone in First Results a closed room (male doctor- Space female patient, female doctor- Management male patient). Ø It is usually the cause of unease and discomfort. in Ø Strategies vary and deal with the Middle Eastern Muslim space (keep door open, have a Culture glass front/window etc.) or with in the individuals in it (take a Denmark chaperone along). Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 29

Intimate parts of the male and female body are called in Arabic Body aura / awra. Management They need to be covered in front of strangers, unless there is a in pressing need (Arab. darûra) , like a Middle Eastern Muslim medical emergency. Culture in The pressing need (Arab. darûra) is Denmark subject to interpretation. Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 37

Intimate parts of the body of the nubile male (male aura): from navel to the knee 38 Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018

Intimate Parts of the body of the nubile woman (female aura): entire body, except the palms of her hands, her feet, and her face Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 39

Ø All interviewees were aware of the concept. Body Ø Relevance is gendered, Management meaning it is more relevant for females than males. Ø Correlation between tension in and covered surface. Middle Eastern Muslim Culture Ø Source of much unease, in possibly tension. Denmark Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 40

Religious (non- binding) edict (fatwa) from a Danish (Moroccan) Muslim scholar about the permissibility of short sleeves for female staff working in Danish health services Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 41

Example: High number of cesarian Body sections for Syrian women in Management Denmark Hypothesis: Women do not in Middle Eastern Muslim want to be exposed with Culture uncovered aura in gender- in mixed birth-rooms. Denmark Annabelle Böttcher, SDU, Odense, Denmark 5.2.2018 33

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