The cost of caregiving : an exploratory study into needs of caregiving and care-dependent Iraqis in the Netherlands

THE

COST

OF

CAREGIVING

A

N EXPLORATORY STUDY INTO NEEDS OF CAREGIVING

AND CARE

-

DEPENDENT

I

RAQIS IN THE

N

ETHERLANDS

FAHAD SAHER FAHAD

GRADUATE SCHOOL OF SOCIAL SCIENCES DEPARTMENT OF POLITICAL SCIENCE

21 JUNE 2019

SUPERVISED BY DR. IMRAT VERHOEVEN A THESIS SUBMITTED FOR THE DEGREE OF

TABLE OF CONTENT DEDICATION I ACKNOWLEDGEMENTS II CHAPTER I 1. INTRODUCTION 1 CHAPTER II 2. THEORETICAL FRAMEWORK 5

2.1

T

HE SOCIAL

S

UPPORT

A

CT WITHIN WELFARE STATE RETRENCHMENT

5

2.2

M

IGRANTS IN THE WELFARE STATE

8

2.3

C

OPING MECHANISMS

11

CHAPTERIII

3. RESEARCH DESIGN 13

3.1

C

ASE SELECTION

13

3.2

C

ASE STUDY DESIGN

15

3.3

M

ETHODS

16

CHAPTERIV 4. ANALYSIS

4.1

M

OTHERLAND AND FATHERLAND

20

4.2

T

HE AVOIDANCE OF GOVERNMENT

23

4.3

T

HE BEHOLDANCE OF GRATUITY

26

4.4

T

HE ILLUSION OF INDEPENDENCE

31

CHAPTERV 5. IMPLICATIONS

5.1

T

HE DISSONANCE OF DESIRES

38

5.2

T

HE TOLL OF CONFORMITY

39

5.3

T

HE TRANSFER OF RESPONSIBILITY

40

CHAPTERVI

6. CONCLUSIONS 42

6.1

T

HE DESIRED OUTCOMES OF THE

SSA

42

6.2

T

HE EXPECTATIONS OF INFORMAL CARE

43

6.3

A

LL ABOUT PERSPECTIVE

?

44

6.4

C

ONCLUDING REMARKS

45

CHAPTERVII 7. POLICY RECOMMENDATIONS 46 REFERENCES 49 ANNEX I 57 ANNEX II 59

Contact:

fahadsahersabry@gmail.com

Student no. 10354530

First reader: Dr I. Verhoeven

Second reader: Dr J.M.J. Doomernik

Word count: 16,915

D

EDICATION

To the Iraqi Community in The Hague who allowed me to listen to

their experiences.

And to my loving parents, Wasan and Saher. I owe it all to your

countless sacrifices.

A

CKNOWLEDGEMENTS

This thesis was a collective effort and made possible only because I was privileged enough to be surrounded with caring individuals. As I close this chapter at the University of Amsterdam with my proudest achievement, I would be remiss if I did not gratefully acknowledge the people who supported me through this process.

To the respondents of my study: you are the beating heart of this thesis. I am ever so grateful for your trust in me. You welcomed me into your homes and shared some of your most personal experiences with me. The courage you displayed served as my inspiration. A special word of gratitude goes out to رﻣﻗردﺑدﻧﮭﻣدﯾﺳﻟا and شوﯾرﻣﮫﺿﺎﻔﺗﻧإهدﯾﺳﻟا. You have been instrumental to the success of my fieldwork. Thanks to your generous and selfless efforts, my eyes were opened to what my thesis would ultimately become.

To Dr Imrat Verhoeven I owe my greatest academic debt. Imrat, you have taught me that quality research is like music from my favourite artists. A catchy beat and impressive lyrics are important, no doubt. But what made their music so good to me? The answer was that these artists had a gift for immersing me into their lyrics in ways that can even resonate with someone who didn’t live their experiences. Thank you for your unwavering support, patience, and consistently outstanding feedback. It has enabled me to write music. My parents have been more supportive than I could express in words alone. We made it. This achievement is as much yours as it is mine.

Hugo, your diligent feedback elevated this thesis to the next level. But most importantly, thank you for your everyday support – it made all the difference. The cherry on top goes out to my close friends who, for better and worse, had a front-row seat on this rollercoaster. I look forward to celebrating this milestone with you all.

F

AHAD

S

AHER

F

AHAD

C

HAPTER

I

I

NTRODUCTION

This thesis marks the interlace of its academic relevance to the social necessity of broadening the academic literature on how different NWI communities fare in an activating welfare state. Following its 2007 predecessor, the updated legislation on the Dutch Social Support Act1 (SSA) came into force in 2015. The SSA is part of the three major decentralisations of the Dutch government to the municipal level, namely care, labour, and youth (Rijksoverheid 2019a). This thesis will focus on informal care as a decentralised practice. What this entails is that municipalities have been put explicitly on the foreground of, and have been responsible for, the care of those in need of it. More specifically, with regard to care for the elderly, this shift in governance demands more self-reliance of vulnerable groups as well as solidarity of those in (close) proximity to support said groups where possible (Grootegoed 2013; Da Roit and De Klerk 2014: 4).

The contemporary research and policies impacting caregivers2 of elderly, non-western immigrants (NWIs) in the Netherlands has been subject to an overdue and long-needed assessment. As of 2018, little over 13% of the Dutch population had an NWI background, whereas this was roughly 10% ten years earlier (CBS 2008; 2018). While a three percentage-point increase might seem somewhat insignificant at first glance, one should take into account that intergenerational differences and cultural tradition inflates this number in terms of how much of the total population in the Netherlands is (i) of non-western heritage, and (ii) how this projection is set to increase in the future. The outlook should, hence, be faced towards the future for this reason.

Dutch society is poised to experience an increase of NWIs elderly in the years to come. In part, this is due to the various migration streams since the 1990s stemming from political,

1 _{Referring to the Dutch Wet Maatschappelijke Ondersteuning (WMO) of 2015.} 2 _{Referring to the Dutch word ‘mantelzorger’.}

humanitarian, and economic insecurity in different parts of the world. Most notably, asylum seekers from states such as former-Yugoslavia, Iraq, Iran, Somalia, Afghanistan, and the Soviet Union ushered in a period of new diversity in the Netherlands (Nidi 2003: 112). This increased diversity, coupled with needs differing from the native Dutch population, sets the stage for the scope of this research project.

Within the demographic of NWIs in the Netherlands, one of the biggest groups is clustered in the Middle East and North African (MENA) region, with Turkey, Morocco, Syria, and Iraq being the most populous communities. It is here that the focus of this thesis comes into play. The Turkish and Moroccan communities have settled in the country since the 1960s and 1970s as economic migrants, and later through family (re-)unification. In recent years, large segments of these communities are part of the second- or third-generation immigrants, which translates to a different type of assimilation and integration in the Netherlands. To illustrate this: by 2015, roughly one-third of third-generation individuals with Turkish or Moroccan roots had a parent with a Dutch background (CBS 2016).

Iraqi and Syrian communities in the Netherlands introduce new challenges which are yet to be addressed. Syrian asylum seekers and refugees who came to the Netherlands as of 2015 are a large, yet particularly vulnerable group who are not always eligible for, nor familiar with, the social support mechanisms of formal and informal care. This is epitomised under the coalition agreement of the Rutte III cabinet in 2017, in which migrants with a recognised status would be denied (direct) access to Dutch welfare provisions (Volkskrant 2017). In turn, this illustrates that welfare state arrangements have been adjusted. This has been done by restricting support mechanisms to the native population, also known as ‘welfare chauvinism’ (Svallfors 1997; De Koster et al. 2013: 6).

This thesis will focus on Iraqis who came to the Netherlands between 1995 and 2005. The justification for this is rooted in the increased arrivals after the end of the Gulf War in 1991 and shortly after the first phase of the 2003 Iraq War. Most individuals who arrived in this timespan and stayed since have been eligible to become Dutch citizens and settle in the country indefinitely. This research project will invest a particular focus on elderly Iraqis and their children in relation to informal Dutch care. Insofar, the scholarship on for example the

Turkish and Moroccan communities has been plentiful (Tonkens et al. 2009; Poort et al. 2003; De Boer 2005). However, the qualitative research on the experiences and the subsequent coping strategies of Dutch-Iraqis with regard to informal care is understudied. The Iraqi community, too, is a vulnerable group but also lends itself to a more suitable dissection of their experiences, challenges, and perceptions. From the mid-1990s onwards, the number of Iraqis coming to the Netherlands as a result of the political, social, and religious persecution, as well as human rights violations and war-linked atrocities has seen a large influx. In concrete terms, there were roughly 8,000 Iraqis in the Netherlands in 1995, and this number rose to over 60,000 in 2018 (CBS 2018). What this implies is that there is a segment of elderly Iraqis who have lived in the Netherlands long enough to have become residents or nationals, yet oftentimes not long enough to get fully familiarised with the social support mechanisms and the reforms thereof in the Netherlands.

One important driver behind the lack of familiarity with social support mechanisms relates to the vulnerable position (elderly) newcomers are in. In part, this can be attributed to their insufficient command of the Dutch language, which directly hampers the access to, and information from, care provisions. This juxtaposes the state and municipalities’ point of departure; citizens ought to be more self-reliant, which entails more ‘personal responsibility’ (Rijksoverheid 2018). The SSA on the other hand does state that ‘those who are insufficiently self-organised or are unable to participate in society, should be able to rely on government-supported care’ (Wettenbank 2015: cf. art. 1.2.1 WMO). However, one ambiguity is that municipalities retain the discretion to translate one’s inability to be self-reliant into the sort of support they might offer. Consequently, the discretion to interpret this, coupled with limited financial resources sets a stage which might feed into inequitable access to long-term care (Jongen et al. 2017: 4).

Furthermore, the idea of ‘personal responsibility’ is inherently linked to one’s available tools to solve existing or impending problems. The underlying question is whether the calls for personal responsibility are compatible with individuals who struggle to master the language, considering that for some aspects in their lives they are wholly reliant on others. Partially due to the linguistic barriers they face, municipalities do not always succeed in reaching, understanding, and addressing their particular needs in with the framework of the SSA.

Consequently, position of Iraqis in Dutch society has undergone a different trajectory than the so-called ‘traditional’ group of Turkish and Moroccan immigrants in the Netherlands. While the traditional groups’ elders have grown up in the Netherlands, this does not apply to the Iraqis. This makes Iraqis who arrived in the Netherlands between 1995 and 2005 uniquely suitable for the following research question:

“How do first-generation Iraqis perceive caregiving and cope with the activating regime of the Dutch Social Support Act?”

This main question also necessitates sub-questions to support answering its different components. These are laid out as follows:

a. Which expectations do elderly Iraqis have of informal care in the Netherlands and how does this hold against their personal cultural background?

b. To what extent are first-generation Iraqis sufficiently equipped to meet the desired outcomes of the Social Support Act?

This thesis is organised in six more chapters after the introduction. The next chapter will address the theoretical framework and the gaps in existing literature. Chapter III present the research design and its limitations. The justifications for its case study design will be discussed in more detail. The aforementioned gaps in literature will in part be evaluated in the analysis, as part of Chapter IV. Additionally, the identified coping mechanisms will be extensively discussed thereby marking new territory in the literature on NWIs experiences with informal care in the Netherlands. Following the analysis, its implications are discussed and reviewed in Chapter V followed by the main conclusions of this study in Chapter VI. Although the main elements of this study will be discussed up until Chapter VI, an additional chapter is added with policy recommendations with proposed pathways forward for the stakeholders involved.

C

HAPTER

II

T

HEORETICAL FRAMEWORK

The theoretical framework introduces the context of the retrenching welfare state through the activating regime of the 2015 Dutch Social Support Act. The decentralisation of care from the state to the municipal level has transformed how state and citizen interact with one another. The SSA does so by tasking citizens to become more self-reliant. This demands a review of (a) why this change was deemed necessary by the state, (b) which purposes self-reliance serve, and (c) which challenges emerge as a consequence of this shift.

Next, the reader is introduced to the various factors which set the stage for the challenges faced by NWIs in general, and former Iraqi refugees in particular. Herein, the foundation is built to examine whether the decentralisation of care takes the particular needs of fragile communities into account. Thereafter, the thesis departs from the known literature and arrives in uncharted territory. The Iraqis who entered in the Netherlands between 1995 and 2005 are one of the few communities in the country who came as refugees, then became Dutch citizens, and finally became a first-generation non-western community to be exposed to the activating regime of the SSA. Traditional notions of non-western communities in the Netherlands will eventually be challenged.

Lastly, literature on coping mechanisms will be discussed to showcase what has been studied and what is yet to be examined. This is done to view the experiences of Iraqis, which will be discussed in Chapter IV, through a suitable analytical lens.

2.1

T

HE

S

OCIAL

S

UPPORT

A

CT WITHIN WELFARE STATE RETRENCHMENT

Prior to zooming into the topic at hand, it is important to delineate what informal caregiving entails in the scope of this research project. The context in which this is assessed in the Netherlands is one of welfare state reform and the decentralisation from state provisions to the municipal level. This decentralisation is done through the Social Support Act (SSA),

which according to the Dutch government sets out the legislative framework that enables individuals to live at home for as long as possible (Rijksoverheid 2015). Consequently, this alters the relationship between citizen and state. New obstacles emerge because the onus of responsibility shifts from entitlements and rights to services one needs to apply for (Van Nijendaal 2014: 88).

Social support in any form is arranged within the context of the welfare state. The welfare state can take on different shapes, which amongst a multitude of other factors depend on the political goals of policymakers and the political and economic context of the state (Hassler et al. 2003; Pierson 1996: 144-145). This thesis will follow the concept of the welfare state as the central redistributive actor for its society (WRR 2006: 32). Traditionally, its responsibilities were to safeguard its citizens’ wellbeing through centralised intervention, uniformity, and equitable access to services (Van Gestel et al. 2009: 14). However, this has gradually become untenable in the Netherlands – in part due to the role of market forces. In practice this meant that a shift occurred from the public to the private domain. Subsequently, the government actively enacted policies that would make the citizen more responsible for its own wellbeing (RVZ 2014). This shift ushers in a further retrenchment of the welfare state and provides the context for the aims of the SSA.

The SSA is a manifestation of a continued trend that stresses self-reliance. It departs from traditional notions of the welfare state which were considered to be too invasive. As a result, the SSA’s desired outcomes were to establish responsibility sharing between the government, civil society in the care sector, and welfare for vulnerable groups (Lub and Uyterlunde 2012: 375; Van Ewijk 2010). Simultaneously, the SSA was also a means to realise large budget cuts in, amongst other aspects, funding in care. Austerity measures have also reshaped the role of the citizen. Social legislation has changed in nature because budget cuts had to be realised (Allers 2015). As a result, citizens are explicitly called upon to consider what they can realise themselves, rather than requesting assistance (Dollekamp and Smits 2015: 10). Moreover, budget cuts directly feed into the scarcity of services. This means that the SSA does not only set out that one ought to be more self-reliant, or reliant on their direct network. Its impact extends beyond that as municipalities cannot always meet the needs of

its citizens, which limits citizens’ ability to successfully apply for care services (Van Nijendaal 2014: 88).

Informal caregiving is defined as the unpaid and often long-term care for family members, friends, or others one may choose to care for (De Boer et al. 2009). This kind of care tends to flow from individuals in one’s direct environment wherein the provision of care stems from the social relation between the recipient of care and the caregiver, meaning that it is not necessarily conferred through a professional setting (Kwekkeboom 1990; Sadiraj et al. 2009: 15). Herein, the position of caregivers is formalised under the SSA and the Long-term Care Act3 (LCA), which together comprise the setting of informal healthcare provision (Rijksoverheid 2019b). The underlying assumption is when one cannot take care of themselves anymore, they can appeal to their informal network. Municipalities aim to promote policies which reinforce dependence on one’s informal network through caregiving and volunteers (Verhoeven et al. 2013: 16-17). One misconception is that the government assumes that every citizen can make an appeal, or that volunteers will emerge to absorb potential shortcomings. In practice, many appear to be unable or unwilling to appeal to or build a social network. Local communities tend to be hesitant to support those with special needs, professionals are not always equipped to deal with their new responsibilities, and clients have a tendency to withdraw into their homes (Verplanke and Duyvendak 2010). The decentralisations of the Dutch welfare state regime have been a major impetuscatalyst for the shift in how citizens interact with the state and its provisions. New challenges have emerged as a consequence. At the core of this shift are the complications citizens experience stemming from the activation of citizens to become less dependent on welfare state provisions in order to become more self-reliant (Newman and Tonkens 2011: 9). Stemming from this shift to individual responsibility, overburdened caregivers emerged as a new challenge (SCP 2019a: 20; SCP 2019b). The shift refers to the strenuous time investment caregiving requires, the inability to divorce oneself from their responsibilities, and the lack of freedom one might have in the choice to provide care (Al Janabi et al. 2010).

2.2

M

IGRANTS IN THE WELFARE STATE

Civic engagement and social support reform come with consequences, which are not always addressed. The activating regime of the SSA has the potential to fuel inequality in terms of who are actually represented in this new framework. Eveline Tonkens and Imrat Verhoeven’s study (2018) found that white, older, higher educated and male citizens tend to be overrepresented in civic engagement (ibid.: 4). Simultaneously, ethnic minorities, younger, female, and lower educated peoples can be excluded – in part due to their lower engagement rates with the public services (ibid).

The position of migrants in the context of welfare state retrenchment and civic activation raises questions of its own. When examining the role of migrant elderly and their caregivers, three overarching factors come into play (Van den Berg 2014: 4). Firstly, the developments of welfare state retrenchment alter the way in which active citizenship is perceived. It calls for a reassessment of the relationship between state and citizen. In doing so, the activating welfare state stresses that state and citizen ought to see each other as partners, recognise each other’s needs, and express a willingness to work towards solutions together (Tonkens and Verhoeven 2011). In turn, this demands a critical examination of the extent in which this partnership in its current form is mutually compatible.

Secondly, the perceptions on and healthcare needs of migrants and the native population may differ vastly from one another. Factors that play into a narrower understanding of migrants’ needs include, but are not limited to, a lack interventions that correspond with the socio-cultural background of migrants (Van den Muijsenbergh et al. 2011), the invisible aftermath of traumatic experiences (Knipscheer et al. 2011), concerns over the accessibility and quality of mental health care (Fassaert 2011), and the pressures with regard to family care (De Graaff and Francke 2003).

Lastly, shifts in how the Dutch welfare state is organised calls for an examination of how migrants cope with these changes. Furthermore, research has suggested that the four largest municipalities4 in the Netherlands have reduced their services available for elderly

minorities. This includes citizens’ advice services that have become more difficult to reach, and a scarce implementation of culturally appropriate care services (Kelderman 2011; Pijpers and Carlsson 2018: 246; Steunenberg and De Wit 2013). If the assumption is to exhaust all other resources prior to requesting social services, and the de facto preferred option of the state, one must also understand how the dynamics of burden- and responsibility-sharing shift. Particularly migrants have an increased likelihood of becoming excluded from, or invisible to, the framework of the SSA (Metz 2009: 37-38).

In translating these abovementioned concerns into the scope of this thesis, three dimensions are added to this already challenging policy problem, namely:

(a) The biggest groups of ethnic minorities in the Netherlands tend to use home care services less than the native population (Forum 2011). Conversely, their caregiving tasks tend to be more intense and time-consuming than that of the native Dutch population. Whilst the latter group spends an average of 21 hours a week, NWIs tend to spend 30 to 44 hours– a 42% to 109% difference (Movisie 2019);

(b) Secondly, that same group has less (access to) knowledge on how to arrange suitable home care services fitting to their needs. A contributing factor to this is that NWIs tend to have a stronger preference to be cared for by relatives and those close to them, rather than formalised home care services (Forum 2011; Movisie 2019); and

(c) Lastly, healthcare professionals, such as nurses, experience home care to NWIs as more burdensome. They feel that they lack the competence to provide the same quality and care for NWI elders compared to the native population. This creates tensions on both the side of those who require professional home care, as well as the side of those who provide it (Suurmond et al. 2015: 23-24).

Building on this, not enough is known about the coping mechanisms of the elderly Iraqi people. The rhetoric linked to the SSA has suggested that the threshold for care provisions has been increased to only those who are ‘genuinely disabled’ (Gustafson 2011). Having to ask one to apply for care services on the basis of being ‘genuinely disabled’ might create new challenges of its own. Grootegoed explains that reliance on long-term care (LTC) links to emotions such as shame and resentment (2013: 146-148). As a result, oftentimes this can lead to a decrease in self-esteem (Schneiderman et al: 1989) and social stigmatisation (Susman 1994). Consequently, it can be argued that whilst it is possible to apply for LTC

within the SSA, there are still limiting factors which inhibit elderly from making use of this service.

Furthermore, there are additional pressures Iraqis traditionally experience. These can be grouped in two overarching themes, namely family structure and family culture. The structural part is linked to the traditional roles that family members assume. In the context of Arabs, this translates to a patriarchal structure whereby the man is at the head (Ismael and Ismael 2000: 185). Additionally, (grand-)children are tasked with looking after of their elders. The traditional differences between Arab5 (Renzaho et al. 2011: 417) and Dutch family culture (Felling 2004) can roughly be delineated between the dichotomy of collectivism and individualism. Individualism appears to be more dominant in Dutch society, in part due to a trend of emphasising personal responsibility, emancipation movements, and the lifting of religious and socio-political barriers (CBS 2017; Linders 2010: 29; Woltjer 2012). On the other hand, Arab collectivism can be characterised as an identity that is based on a social system that relies on trust and loyalty to the communities and clans to which they belong (Obeidat et al. 2012: 515; Buda and Elsayed-Elkhouly 1998: 488). Additionally, family influence plays an important role and is generally ‘ever-present’ (Hofstede 1983). This appears to correspond with what is encouraged under the SSA, namely the caring and solicitous role citizens should assume. Studies on the perceptions of, for instance, Turkish and Moroccan are plentiful. For them, collectivism remains a guiding principle. This translates to a strong preference for being taken looked after by their (grand-)children (Forum 2011; Van Middelaar 2010; Pharos 2014).

The SSA’s appeals to self-reliance through collectivism may, at first glance, be compatible with how Iraqi family culture is generally arranged. The underlying question is whether and if this presents complications of its own when these notions are challenged. Consequently, this poses a tension between expectations of care from the elders, what caregivers can and are able to provide, and why the SSA was signed into law. Notwithstanding, it should be

5 _{NB: In the context of this thesis Middle-Easterners, Arabs and Iraqis are intentionally not used} interchangeably. While a significant number of Iraqis also identify as Arabs, neither should be perceived as monoliths. Throughout the thesis arguments will be presented as to how Iraqis in the Netherlands break with traditional Arab cultural notions.

stressed that this thesis examines a different community and could therefore present different outcomes. Therefore, it is taken into consideration that as a whole Turks and Moroccans do not identify as ethnic Arabs. Additionally, whilst traditional perceptions are examined (cf. Ismael and Ismael 2005), the literature on how any Arab community experiences informal care in the Netherlands is scarce. Consequently, contemporary research on the perceptions and experiences of Turks and Moroccans cannot be extrapolated to Iraqis in the Netherlands without scrutiny.

2.3

C

OPING MECHANISMS

Oftentimes, stress and coping are two sides of the same coin. In broad terms, stress can be defined as ‘the unpleasant state of emotional and physiological arousal that people experience in situations that they perceive as dangerous or threatening to their well-being (Folkman and Lazarus 1980). Linked to this, coping is described as ‘the cognitive and behavioural efforts to master, reduce, or tolerate those demands’ (Baqutayan 2015: 479). Because the two are interlinked, stress may trigger coping mechanisms which could manifest in anxiety, worry, shame, or anger. Additionally, stress could become part of a vicious cycle which could occur when demands exceed one’s ability to cope with them (idem: 480). Research on stress and coping suggests two primary distinctions in the form of problem- and emotion-focused coping mechanisms. The former drives a shift in personal demands which give cause to stressful situations, whereas the latter is linked to changing one’s own stress responses that are caused by their situation (Aldao et al. 2015: 265; Folkman et al. 1986). Consequently, stress and coping may take on various shapes and understanding their driving factors is key in presenting a holistic picture of this study unpacks them.

Furthermore, inspired by the works of Ellen Grootegoed (2013) and building on that of Arlie Hochschild on managing emotions, Hochschild’s research explains that individuals change their emotions in order to let them align with what they consider to be appropriate for its social context (1979: 567). These contexts are adjusted through so-called ‘feeling rules’ and ‘framing rules’. The former refers to the rules that govern how one reviews how aptly feelings correspond with its particular situation, whereas the latter describes the how one attributes definitions or meanings to that situation (ibid: 566). According to Hochschild, feeling and framing rules tend to be back-to-back and mutually imply each other (idem). By linking

these rules to how Iraqis cope in a retrenching welfare state, one might gain insights on how their expectations hold against the resources available to them. In turn, this sheds a light on (a) how they cope with a potential mismatch and (b) to what extent they are able to adjust to the rules governing the SSA.

The scholarship on the perceptions on (in)formal care by NWIs is ample enough for a foundation. Whilst some divergent perceptions on socio-cultural differences, family structure and culture, and their expectations of healthcare at large have been researched, coping mechanisms have not enjoyed similar exposure. Additionally, neither perceptions nor coping mechanisms have been satisfactorily researched for the Iraqi community in the Netherlands. Notwithstanding, literature points to similarities between family structure and culture between Turks, Moroccans, and Arabs. The circumstances under which these communities came to the Netherlands however, differ vastly. Similarly, perceptions on how they have assimilated in the Netherlands may not correspond either.

What is key to consider are the circumstances under which Iraqis migrated to the Netherlands. Many were tasked with rebuilding their lives as a consequence of fleeing an authoritarian regime, the onset of war, and ultimately widespread instability. Moreover, one could note the triple burden of coping with daily life through integration, social responsibilities towards one another stemming from cultural embeddedness, and realising access to society, social institutions, and social rights (Van Ewijk 2006: 16). Through the works of Aronson (2006), one might understand that coping mechanisms might be more latent than meet the eye. He illustrates a case wherein Canadian women did not complain about severe budget-cuts in home care services to anybody. Fear, amongst other factors, played a role in their accepting attitude, which ultimately drove them to accept the new norm they found themselves in. This study serves as an illuminating example of how problem-focused coping mechanisms can shape how one handles dire circumstances. Studying vulnerable groups therefore calls for detail-oriented research where an emphasis is placed on the feeling and framing rules in a context of fewer available resources (Grootegoed 2013: 149).

C

HAPTER

III

R

ESEARCH

D

ESIGN

3.1

C

ASE SELECTION

In order to conduct in-depth research, a case study design lends itself as a suitable tool for analysis. Herein, one may gain a deeper understanding in what the research problem at hand is (Bryman 2012: 142), which enables the aforementioned aim to provide an ‘illuminative evaluation’.

The choice to assess the experiences and coping mechanisms of Iraqis is rooted in two arguments. Firstly, there is no academic research dedicated to their experiences with the formal and informal healthcare system in the Netherlands. For the most part, their experiences have been clustered in those of ‘traditional’ migrant groups in the Netherlands, such as Turkish as Moroccan communities. This choice, or assumption, does not correspond with their demographic reality, considering that the vast majority of Iraqis are newcomers to the Netherlands upon their arrivals from 1995 onwards. Turkish and Moroccan communities have been in the Netherlands for several generations, and perhaps more importantly, left their country of origin under different circumstances. An overwhelming part of Iraqis in the Netherlands did not migrate from their country of birth for exclusively economic reasons; they arrived as refugees who were forcibly displaced under life-threatening circumstances. This is to illustrate one-size-fits-all approach for non-western immigrants does not necessarily have to apply considering the diffuse contexts and needs the communities might have.

Secondly, over the course of the past decade in particular, we have observed that more refugees and asylum seekers were (forcibly) displaced and arrived to the Netherlands. Their countries of origin include Syria, Eritrea, Afghanistan, and Somalia (Sociaal-Economische Raad 2019). This entails that the Iraqi newcomers, who are Dutch citizens by now, can serve as a point of entry to understand which needs and coping mechanisms refugees might have when arriving to their new host society. Therefore, the choice to gain a deeper understanding in the experiences and coping mechanisms of Iraqis within the activating

regime of the SSA is as much focused on the past and present as it will be on the future.

The type of case study must be chosen accordingly. Considering that the spread of Iraqis in the Netherlands is scattered across the country, the utility of information needs to be maximised from small samples (Flyvbjerg 2006: 230). This entails that the chosen municipality needs to be:

(a) populous enough to find a satisfactory number of respondents;

(b) employ a culturally appropriate care approach which takes the needs of the various backgrounds of its citizens into account; and

(c) able to demonstrate that it has a clear idea of the challenges that caregivers face and the kind of support they can provide to (partially) meet those needs.

Inspired by Flyvbjerg’s reasoning (2006: 231), this research project adopts the ‘if/then’ line of reasoning; if the gap between the needs of, as well as the existing SSA mechanisms for, first-generation Iraqis is experienced as difficult there, it is likely going to be difficult in many other cities and regions in The Netherlands. For this reason, the most suitable case study is a ‘most likely critical case’.

The city of The Hague is chosen as the setting for this case study as it has the highest number first-generation Iraqis living there, and, additionally, the second largest number of second-generation Iraqis (CBS StatLine 2018). Furthermore, caregiver organisations in The Hague, such as PEP Den Haag, have dedicated information forums with the aim of informing on, and advocating for, culturally appropriate support for caregivers. In the past years, 25 organisations for migrants and 2.500 persons with a non-Dutch background have taken part in their meetings (PEP Den Haag 2019). Furthermore, the city council of The Hague has been aware of the needs of overburdened migrant caregivers since 2011 – well before the SSA’s current update (Gemeente Den Haag 2011). Lastly, the municipality of The Hague has drafted a dedicated action programme named ‘Haagse kracht van zorgvrijwilligers en

mantelzorgers’6 _{when the 2015 SSA came into force. Herein, extensive research has done on}

6

how many (recorded) care-dependent and caregiving individuals live in the city, which challenges they face, how the municipality aims to make resources available to support them, and what their available budget is (Gemeente Den Haag 2015). While no proposed path forward is presented, its conclusion implies that the municipality has a role to play in better implementing its own objectives.

3.2

C

ASE STUDY DESIGN

As the research topic has not been studied in-depth, this study is intended to determine and maximise the discovery of factors contributing to the description and understanding of the social phenomenon (Stebbins 2001: 3). For this reason, this thesis lends itself to an exploratory study of the experiences and coping mechanisms of Iraqis within the activating regime of the SSA in the case of The Hague. Generally speaking, an exploratory study is a suitable methodological approach when “researching a group, process, activity or situation that has receive little or no systematic empirical scrutiny or has been large examined using prediction and control, rather than flexibility and open-mindedness” (ibid: 7).

In order to build a robust case, one must also consider the group at the heart of the study. The case study design enables the researcher to tailor the study in a detailed and in-depth manner (ref.). Herein, a case is defined as a “class of events”, which refers to the study of phenomena of specific interest with the aim of developing generic knowledge (George and Bennett 2005: 82). A case study is therefore a well-defined aspect of the subject, rather than the subject itself (ibid). Furthermore, case studies can be stronger than statistical models through four advantages they can bring to the table when developing of theory and testing hypotheses: first, a stronger case can be built for its conceptual validity; second, they can be used to postulate new hypotheses; third, they can shed a light on the causal mechanisms of individual cases; and last, they foster a design that is suitable for addressing causal complexities (George and Bennett 2005: 87).

Nevertheless, case studies have their shortcomings too. Trade-offs are to be made when opting for a case study. The researcher ought to consider the strong suits and shortcomings of having to choose between a parsimonious or rich approach when looking for explanatory factors. Considering that the literature on this topic is scarce, the chosen way forward is one

of detailed and rich descriptions. This is rooted in that this case study has a particular interest in examining the conditions and mechanisms under which certain outcomes occur, rather than the frequency in which they come (idem: 133).

Bearing in mind the topic at hand, the ‘most likely’ critical case is considered the most suitable design. A critical case strategy aims to gather information that allows for coherent deductions (Flyvbjerg 2006: 230). When the findings are not valid for this particular case, it does not apply to other cases either. In applying this design, the aim is to gain a richer understanding of how Iraqis in the Netherlands experience caregiving. The municipality in which the information will be gathered will therefore have to be most conductive to the success of this.

3.3

M

ETHODS

For this primarily qualitative research project, the main mode of data collection will be through conducting semi-structured interviews. This technique will be used as it will enable the researcher to go through their inventory of topics they wish to cover, and even change its order, whilst allowing the respondent to express their views, perceptions, and experiences freely and unreservedly (Rabionet 2011: 564; Bryman 2012). In practice, this entails that there are themes (cf. Annexes I and II) that every interview had to encompass. Within these themes, corresponding questions were formulated. As an interviewer, I retained the discretion to – when appropriate – deviate from the planned chronological order of questions in order to establish a better report with the respondents. Studies suggest that a degree of flexibility, emotional reflexivity, and a curiosity for the respondent are important when addressing sensitive topics (Suchman et al 1997; Langewitz et al. 2002). It is precisely this kind of empathy that was necessary to establish a report with the respondents of my study that was rooted in genuine curiosity, honesty, and the respect that they deserve. Additionally, this flexibility enabled me to cover topics relevant to the study but necessarily accounted for prior to the interview.

The respondents for this research project can be split up in two groups, namely: Iraqi elderly (> 55 years old) who came to the Netherlands from 1995 onwards and the children of, or

those close7 to, the aforementioned elders, who are first-generation immigrants to the Netherlands who provide the primary support in caregiving tasks for their parents/elder. For this reason, one of the approaches employed to gather data was through ‘purposive sampling’. This entails that the respondents were deliberately chosen on the basis of qualities they possess (Etikan et al. 2016: 2-3). This method of research is particularly suitable when selecting cases that are rich in information whilst using limited resources (Patton 2002). What this does is involve individuals who are knowledgeable about or experienced with the topic of study (Cresswell and Plano Clark 2011).

This exploratory study can form the basis for follow-up research, which is why the municipality of The Hague was deliberately chosen. In this particular instance, ‘critical case sampling’ is the most suitable method as it aligns with Flyvbjerg’s notion of “if it happens here, will it happen anywhere?” (2006: 231). Critical case sampling lends itself for precisely this, as it is a suitable method to determine whether follow-up studies are warranted (Etikan et al. 2016: 3).

A total of eight interviews were conducted in which there were conversations with eleven respondents. The difference between the respondents and interviews can be attributed to the fact that three interviews were conducted with elderly couples. The topic list for questions was specifically adapted (see Annex) for these three interviews to gain insights in the experiences of both spouses. The division of the elderly and caregivers is illustrated as follows:

Caregivers Elderly

Male Female Male Female

0 3 3 5

The gender-balance leans heavier to the female respondents, and this can certainly be acknowledged as a shortcoming. A gender-sensitive approach throughout the interviews and analysis was employed as much as possible considering the limited availability of willing

respondents. Encouraging respondents to participate in this research project proved to be a challenging task, which ought to be addressed in future studies on the topic. In the case of my thesis, a combination of two factors contributed strongly to the respondents’ acceptance of my request to interview them. Firstly, as an Iraqi-born researcher, the respondents were able to speak to one of their own community. Particularly my ability to converse with them in the native Iraqi-Arabic dialect allowed the respondents to speak more freely than in, for instance, Dutch or English. Secondly, through contacts in my network, I was able to secure the first two interviews. Hereinafter, through snowball sampling the respondents of my study referred me to others who might be suitable for my research (Kapiszewski et al. 2015: 212). Snowball sampling is an effective tool that allows to gain access to so-called ‘hidden populations’, be it by choice or otherwise (Noy 2008: 330-331). The analysis will demonstrate why for some Iraqis this has been a case of ‘hidden by choice’, which retroactively explains why access to the field has proved to be a challenging task. Through access to my first respondents, and these respondents in turn persuading others from various backgrounds and affiliations, the fieldwork took off.

Furthermore, my understanding of cultural customs and habits contributed to building a trustworthy and comfortable report. All interviews lasted between 30 and 55 minutes. When conducting the interviews in the homes of the respondents of my study, this sense of trust and familiarity was indispensable in establishing a conversation rooted in trust and openness. Upon entering the field and completing the interviews at a relatively early stage in the process, I started to unpack and code the material. This was done by listening to all the interviews twice, during which key moments were transcribed and manually coded. Because the interviews were conducted in Iraqi-Arabic and then translated to English, I retained the discretion to not transcribe the material in coding software, but rather cluster the topics in mind-maps and colouring schemes. In turn, this allowed me to analyse the material in a way that was tailored to the themes which are unpacked in Chapter IV.

Lastly, for reasons apparent in the following chapter, I have opted to anonymise all respondents of my study. Not all respondents have explicitly asked me to anonymise the interviews. However, as a researcher one must make ethical considerations. The respondents of my study are part of a community where they know one another, be it directly or

indirectly. Their generosity allowed me to talk to them about deeply personal, and sometimes traumatic events that have occurred in their lives. For these reasons, the respondents of my study have been given fictive names. Additionally, out of respect in Iraq it is common tradition to address one by their ‘kunya’. A kunya is a component of an Arabic name referring to the person’s first-born son or daughter. This is expressed by either ‘Abu’ (father of) or ‘Umm’ (mother of), followed by the name of their first-born.

C

HAPTER

IV

A

NALYSIS

In order to better grasp how the elderly NWIs perceive their own situation in relation to if and how they interact with the municipality, it is imperative to compare and contrastthis against the experiences of the caregivers. This chapter will be dedicated to the stories of the elderly and caregivers. Insofar, the social, political, and academic debates on the topic of non-western immigrants’ perceptions and experiences has been informed by communities who have been in the country for more than one generation. The findings in the following analysis will highlight experiences and needs that differ from what is known about the topic to date. In part, this is due to their unique position as relative newcomers to Dutch society who by now have become naturalised citizens.

This chapter will inform the rationale behind why care-dependent and caregiving non-western immigrants should not be seen as monolithic or homogenous groups in Dutch society. Herein, the building blocks are prepared for the remaining three chapters, which respectively deal with the implications of the analysis, the conclusions of the study, and finally which policy recommendations can be considered to address the needs of first-generation Iraqis. The underlying question that arises as a result of this is what factors inform how Iraqis experience and cope with the challenges they face.

4.1 M

OTHERLAND AND FATHERLAND

Immigrants are composed of a heterogeneous group in society. This translates to various perception on and experiences with public services. The differences, in part, depend on complex factors which include but are not limited to the person’s cause for migration, their personal situation upon arrival, and the degree in which they absorb their new country’s formal and informal rules.

This relates to the views the Iraqi respondents have towards their new home country, the Netherlands. Most importantly, none of the respondents have any appetite to live in Iraq again, and have accepted this. In turn, this resulted in a strong connection to the Netherlands. When elaborating upon this in the conversations with the respondents, one theme in particular resurfaces: the acceptance of their new home in the Netherlands. The respondents of my study shared what miss about their country of birth whilst also highlighting what the Netherlands has given them. Umm Adil, who can only be described as a gentle motherly figure, phrased this in a particularly memorable manner when talking about what gives her comfort in her new home:

“Since I arrived here, I’ve always felt taken care of and encouraged. I feel comfortable here. This country has accepted me and it is my country too now. Of course, I miss my country of birth; I was born there, made my friends there, and my parents were there. I live in a world apart now though. This country has given me encouragement, confidence, a sense of safety and security, and everything I possibly lacked.”

In similar fashion, Abu Majid – who above all was delighted that someone was willing to listen his experiences – expressed in simple terms why his family left. When implying in the conversation that they are better off in the Netherlands, despite not knowing how to rebuild their lives in their new home country, he said the following:

“Coming to the Netherlands at my age was difficult. Difficult, might not cut it. But we had to, whether we liked it or not. We had no voice there.”

Abu Majid’s wife, who oftentimes provided the necessary context to understand their situation, complemented him:

“Our lives there were untenable. We sent our son ahead of us [to the Netherlands], and then we followed him. We nearly lost my husband. We suffered a lot.”

Whilst every story is a unique one, it does fit a pattern of why the respondents feel a strong affiliation with the Netherlands and what they miss about Iraq. These are stories of individuals being torn between the warm safety of a country that they consider home and a desire for a country they could not have. Umm Aisha, whose life experiences helped placing others’ in perspective, explains how staying in the Netherlands was a deliberate choice.

Despite the fact that assimilating here was no easy achievement for her either, she explained how life in the Netherlands for her meant peace of mind:

“We had to leave Iraq for our own safety. Our son used to live in Poland, his wife is Polish. We stayed there for a while, but we experienced life there to be very difficult for us. So, we decided to leave Poland. Our arrival to the Netherlands wasn’t easy either. I’ve been in Germany for a little while before coming to the Netherlands. But I experienced the Germans to be of a different mind-set… They have no respect for others… I experienced them to have a very dark world-view of others.”

Interviewer: Did you experience this to be different in the Netherlands?

Umm Aisha: Fundamentally. When we arrived, so many people had to wait for such a long time at the asylum seeker centres before getting a residence permit. We received our residence permits in fifteen days. They recognised that our situation was beyond recovery. Our worries of pursuing of a new home disappeared.”

What stands out in the stories of Umm Adil, Abu Majid, and Umm Aisha is what specifically they appreciate about the Netherlands and what they miss about Iraq. None of the respondents have expressed a strong loyalty to their home country. Whilst they all indicate that it has been very trying to rebuild their lives here at their age, what they miss about Iraq has nothing to do with patriotism. Instead, Umm Adil eloquently phrased it as a sense of belonging. After all, it is where one’s family and friends once were.

Every single respondent came to the Netherlands as a refugee, fleeing from an authoritarian regime and in pursuit of a safer home. This breaks with the literature known on ‘traditional’ migrant groups in the Netherlands, such as the Turkish and Moroccan communities. Parts of these communities feel partially connected to the Netherlands; many have double nationalities and thus the Netherlands is not their only ‘home’ (Kremer 2013: 39; Snel et al. 2006). Research on the topic has also illustrated the stark differences between ‘traditional’ migrant groups and the perceptions of Iraqis. One large-scale study highlighted that nearly 80 percent of Turkish and Moroccan respondents feel (very) strongly connected with the country where they have their roots (Huijnk and Andriessen 2016: 211). Whilst Turkish and Moroccan communities might feel a strong connection to the country of their roots, Iraqis in the Netherlands have no particularly strong patriotic attachment nor the desire to return.

Consequently, this affects the relationship between the different migrant communities

vis-à-vis the state. Tonkens and Verhoeven already illustrated that the desired outcomes of the

SSA flow from a mutually recognised relationship between state and citizen (2011). The differing affiliations of Iraqis illustrate that their position is more conductive to a successful outcome. What remains is the question of whether this translates to a mutually compatible relationship in practice.

4.2 T

HE AVOIDANCE OF GOVERNMENT

The stories shared by the majority of the respondents of my study can be tied together under a common theme. One driver for the sense of belonging Iraqis feel towards the Netherlands stems from what has repressed them for decades. Living under an autocratic regime inevitably shapes one’s outlook on the world – particularly if you have never known another reality. The respondents my study’s answer to this can be linked to emotion-focused coping mechanisms. Herein, one’s stress responses shift as a result of the situation they are in (Aldao et al. 2015: 265; Folkman et al. 1986). Studies have been conducted with regard to mapping stress and trauma responses by Iraqi refugees after settling in their new host societies (Shoeb et al. 2007; Slewa-Younan et al. 2015a; Slewa-Younan et al. 2015b). Whilst these studies conclude that many of the stress responses as a result of state repression, the findings do not focus on how the victims of repression cope with the aftermath. This thesis argues that one of the corresponding coping mechanisms that the majority of respondents is to steer clear from interacting with the government. This coping mechanism from hereon will be coined as ‘the avoidance of government’, which in Dutch translates to ‘overheidsontwijking’. The following examples from the interviews support how the avoidance of government is manifested.

In a story told by Abu Majid, who profoundly influenced the course of this research early-on through sharing some of his most testing experiences, early-one might start to understand how the conditions of arrival for many Iraqis is different than what we know about traditional NWI communities in the Netherlands. He painted a vivid picture of the hardships faced by many Iraqis who lived under Saddam Hussein’s regime.

To them, a part of their lives is characterised by a sense of psychosocial fear that everything might be taken from them. When their new home offers them the aforementioned “sense of safety and security” that they lacked in their country of birth, the threshold of acceptance for government-driven aid is strikingly low. Abu Majid shared a personal story, which is all too familiar for many Iraqis:

“We tried to leave Iraq earlier, but we came back when the country went to war with Kuwait. It was very hard for us. We eventually came back to Baghdad. One day, one of Saddam Hussein’s men summoned me to my [goldsmith] shop, and I went. I faced a group; one went to the safe, one went to the windows, and one stood in front of me. (…) The men told me a story about how I had a stolen necklace in my shop. They continued to intimidate me [for money or a confession], asking me about my eldest son and describing him in detail even though I had never met these men before. I had to deny his existence to protect him. Either I could confess to a crime I never committed or I had to fear the worst.”

Through these traumatic experiences one might understand the interactions with government-driven programmes or the lack thereof. The episode Abu Majid described was by no means an exception. Harassment, theft, forced disappearances, or worse were common under the regime’s watch and have been cause to trauma, post-traumatic stress disorder, and anxiety for Iraqi refugees (Shoeb et al. 2007: 451). Mental illness is highly stigmatised in Iraq as, for example, its presence can bring shame upon families. Furthermore, it is not uncommon that a traumatised person or their next of kin would be considered unfit for marriage by their family or community (ibid.: 456). This leads to the suppressing, dismissing and/or acknowledging of specific needs they might have. A common way to cope with the atrocities committed to them by authorities meant staying far away from any government institutions and officials. In doing so, they contribute to their own personal detriment. After all, in their experience government institutions have been a cause of misery – trust cannot be regained on the basis of goodwill alone. In doing so, their coping strategy manifests itself in not protesting what the state has to offer. Whichever social support mechanism is offer, will be silently accepted.

When asked about their interactions with the municipality, more than half of the answers concerned the notion of avoidance. Umm Adil for instance, responded as follows:

“I don’t really have anything to do with the municipality.”

Interviewer: “The municipality’s role in care has increased and you could apply for some your care needs. Do you get in touch with them if you need anything?” Umm Adil: “No, no, no, there’s absolutely no contact with the municipality. Nothing. I don’t have anything to do with them.”

Particularly the idea of having to interact with the municipality seemed somewhat daunting to her when talking about the matter. Furthermore, Umm Aisha was more explicit on the matter. When discussing her experiences, she was forthcoming and stated:

“I absolutely do not trust them.”

Whenever she would interact with them, she would find the experiences to be frustrating and would prefer to stay as far away from them as possible. Umm Kadar also shared that her experience as a caregiver for many elderly she observed a similar tendency:

“They are probably scared that someone might come into their homes when they seek help. They won’t allow that. Some are genuinely scared.”

This is not an uncommon fear some might have, as it happened on a regular basis under the regime in Iraq.

Umm Kadar: “It makes me very sad to see my friends and others I know go through the same. (…) The elders are scared to get help and treatment. They don’t trust easily and reject help.” Their traumas also manifest in the form of gratitude for whichever provisions are provided and the hesitation to ask for more. Highlighted cases below illustrate a particular manifestation of the avoidance of government. This can take shape in limited contact with the government by not contesting the support one receives. This is exemplified in, for instance, the seemingly contradictory statements by Abu Majid when stating:

“We are very happy with the municipality and how they take care of us.”

It is however the same municipality who, in his own words, requested him to move if he was not satisfied with the current home situation he is in when informing about the building’s shortcomings for those with mobility issues. Three minutes earlier in the conversation however, he shared with me that it is his son, who lives over two hours driving from The Hague, has to go above and beyond to care for them. Here, Abu Sadiq provides more insight

with the expectations he has of informal care, whereby no connections are made with how this holds against his personal cultural background.

“Our son and his wife help us with everything; the cleaning, the caretaking, the grateful and ungrateful work. For them it doesn’t matter how many hours they’re helping. (…) We rarely get any help or assistance from the municipality.”

Abu Sadiq expressed similar sentiments. When asking about how he sees the provisions he currently gets, outside of the full-time care he receives from his wife, he hesitantly stated:

“…Truthfully, we could use more assistance. But this could be enough, I should not complain either.”

The premise of the conversation with him however revolved around a story he told me about the year of work it took him to get assistance with basic translations of services he required due to his declining eyesight. This was one of the many examples where the system had failed him.

4.3 T

HE BEHOLDANCE OF GRATUITY

This study’s findings suggest that the rights and liberties Iraqis enjoy in the Netherlands are strongly linked to a sense of gratitude and loyalty towards the state. The connection that Iraqis feel towards the Netherlands, as illustrated in section 4.1, is a factor herein. Their new home in the Netherlands could not be more different. The Dutch democracy relies strongly on political rights, civil liberties, and freedom of expression, all of which most Iraqis have never known in their country of birth. In practice, this translates to an overall satisfaction with the provisions they receive irrespective of how scarce or limited these might be or whether they are eligible to receive more.

When combining the distance to their children with a lack of a strong social (support) network, the odds continue to stack against an already fragile community. As indicated by themselves, this has a demoralising effect which further feeds into a coping strategy of lowering expectation and a general acceptation of whichever provisions are at their disposal. In addition to this, there tends to be an emphasis on what one does have rather than what lacks. In large part, the gradual lowering of expectations flow from the aims that the SSA

sets out. Altogether, this entails that the SSA’s activating regime has played a role in shaping their feeling rules.

Another reoccurring theme is that one should not complain about what you do receive in help as it is unlike what is known to them before. The gratitude towards their new host country supersedes most desires they hold. The barrier that appears as a result of this, is one that hereinafter will be referred to as the ‘beholdance of gratuity’ – or ‘verschuldigingshinder’ in Dutch. This term refers to the tension that arises as a consequence of the gratitude towards the state and the negative externalities it brings with it in the form of a sense of guilt to ask for more. At the heart of, and a main driver for, the hardships especially the elderly face is the linguistic barrier. With ages ranging from 47 to 60 years when they arrived in the Netherlands, they have all indicated without exception that language was one of the main obstacles they faced when striving to be self-reliant. While they all have sufficient proficiency to articulate themselves in basic, everyday conversations, it should be noted that even a small margin of error when it comes to voicing one’s personal health concerns could have life-threatening consequences. Simply put, the underlying observation that guided this theme of the conversation is the tension between (a) the state’s desire for newcomers to master the Dutch language and (b) the potential healthcare concerns they might face when this is not the case.

Furthermore, section 4.1 has established that the Iraqis who fled their country of birth have also embraced the Netherlands as their new home. Linked to this is the desire to master the language. Becoming proficient in Dutch is an essential part of the newcomers’ integration process. Yet, the experiences of particularly elderly Iraqis upon undergoing this process highlights that this was enforced inconsistently. One reoccurring theme that surfaced was when some elderly were told that they “did not need to bother to master the language, considering their age, personal circumstances, and the effort it would take”. This issue was raised independently in the conversations with Umm Aisha, Abu Yasir, and Umm Adil. In the latter case, Umm Adil at first did not realise the ramifications of this, as the was under the impression that it was implied that the state would look after her:

“All the information I received was in Dutch, and I could cope since I went to a school to learn the language. (…) When they learned that I also took care of my

husband because of his [medical] needs, they exempted me from having to spend more time there. I felt very encouraged and supported.”

While she experienced this as a positive gesture at first, it also became apparent that once she required caretaking this hampered her ability to be express herself in Dutch.

Consequently, this prevented Umm Adil and others from becoming self-reliant in certain situations. The assumption for her, and the others, was “the state will support us and make it work”. Their everyday realities however underpin that this was a mistake. As a result, this leniency illustrated that once the state retrenched, most of the respondents of my study became more reliant on others. One concrete hardship the elderly face in particular is when they receive letters from their general practitioners and hospitals regarding their healthcare needs. These documents are communicated in Dutch only, which means that by default they have to resort to others to understand their contents. A seemingly simple interaction for them has now become a matter of urgency where someone needs to be found who they trust and can translate its content.

Upon having established the elderly’s illusion of independence, the sum of this situation puts the elderly in a particularly complicated situation which negatively affects their ability to interact with healthcare professionals. Abu Yasir illustrated the urgency of this matter in a manner that breaks with the widely-accepted notion that other communities from the Middle-East and North Africa, such as Turkey and Morocco, self-evidently take care of their elders, in part due to religious instruction and/or cultural customs (Morée 2005; Gowricharn 2001: 33):

“At this point, I don’t have a preference for who looks after me – as long as that person mastered the Dutch language. If that person is from our community, that’s a bonus.”

When focusing the conversation about their ideal solutions, every single respondent hoped to gain support from the municipality for one particular need: the translation of documents essential to their healthcare needs to Arabic. Umm Majid, who sat next to her husband and intermittently gave valuable insights, phrased this in a particularly constructive way:

“All we crave is translations, so that we can help our fellow brothers and sisters – irrespective of their religion, ethnicity, or country of origin. We can sit together, and help each other better. (…) Yet, we are very happy with the municipality!”

Furthermore, the elderly’s inability to carry out simple tasks such as understanding the contents of a letter presents another dilemma for both generations. The elderly Iraqis I spoke to wish to give their (grand-)children the space to flourish and succeed in their new home country. One key driver for the elderly’s hesitation to accept assistance from their (younger) children is their desire to build a better life for themselves, in which they see themselves as an obstacle. This is illustrated by Abu Yasir selfless and Abu Sadiq’s supportive attitude of their children’s choice to live far away from their parents, whereby the former lives in the other side of the country and the latter’s children live in Australia – both as entrepreneurs. Abu Yasir and his wife were generous enough to be completely transparent throughout the conversation – to a disarmingly honest extent. The fact that someone was willing to listen to their grievances clearly meant a great deal to them. He explained his dilemma as follows:

“No one lives nearby. My children live 200 kilometres from me, they all either study or have businesses. There isn’t anyone around to really help. It’s like being stranded on a desert. (…) I send photos to my children to help me translate letters. But they’re busy. (…) They’re only here for short amounts of time.”

Abu Yasir’s situation illustrates that whilst technology can play a role in bridging the gap between the care-dependent and caregiver, it does not suffice to address the core problems care-dependent individuals have to face. Research suggests that larger distances between them form significant obstacles in providing adequate care (De Boer 2005; Dautzenberg 2000; Knijn and Liefbroer 2006; Linders 2010).

“We feel completely lost.” Abu Yasir said, to which Umm Yasir added: “Were satiated with sorrow, my dear.”

Throughout the conversation, it became evident that even though he would be more comfortable with having them around, his wife and he strongly feel that they should not be a limiting factor in their success here. Their personal needs are secondary to what they believe is best for their children – even if that means that they suffer from it. In addition to