G Deverteuil

A.-C Hoyez

Thomas

; Thomas

Gideon

Chapter title: Health System and Immigrants - a focus on urban

. Urban areas, characterised by various forms of concentration, proximity, and plurality, are challenged by analyses that highlight the role of various economic and

social processes in increasing precarity and marginalising vulnerable groups (Amin and Thrift 2016). Precarity among some segments of the population, generated by different processes of classification, social hierarchisation, social differentiation in urban contexts, is part of a more global tendency towards an increasingly exclusive collective identity, based on the weakening of social links, which, in turn reinforces the exclusion of immigrants, racial minorities and asylum seekers (Amin 2012).

In this chapter, we aim to present the nexus between urban living and health as it occurs in France. We then focus on the particular situation of immigrants in terms of health.

Our observation of their situation enabled us to make inferences not only about immigrants' experiences but also about the healthcare system, whose efficiency is not only challenged but called into question, particularly in urban environments. In this article, we focus our attention on the links between precarity and access to healthcare. Regarding social contexts, newly arrived immigrants are highly represented among economically deprived and precarious populations. In particular, they are more than others excluded from access to resources (by effects of direct or indirect discrimination processes), they are more represented among people who attend specific' healthcare centres (such as dispensaries run by humanitarian NGOs), and their healthcare pathways are mostly constrained by their living conditions, notably residential precarity.

French national statistical data can shed light on the 'concentration' of immigrants in urban areas. Thus, the data provided by the INSEE concerning the population distribution indicates that immigrants are more spatially concentrated than natives [START_REF] Brutel | La localisation géographique des immigrés[END_REF]): 8 out of 10 immigrants reside in urban centers (against 6/10 for nonimmigrants). More specifically, 38% of all immigrants living in France, reside in the Paris area (against 17% for the nonimmigrant population). This reflects a historical tendency of the geographical concentration of immigrants in urban areas, which has recently been reinforced by new migratory contexts: 89.6% of newly arrived immigrants (<5 years) settle in urban areas and one-third of these live in the Paris area. It must also be noted that immigrants represent an important part of the total population in urban centres outside of Paris. Apart from these demographic configurations, large cities have the particular characteristic of being home to sites considered as 'places of exception'. This is the case of Calais, in Northern France (it embodies the border between France and the UK) and La Chapelle (a neighbourhood of Paris), which have, in recent years, been in the spotlight of the media for being precarious forms of collective shelter for newly arrived migrants.

Thus, issues related to health and precarity among immigrants living in urban environments have given rise to major political and social debates. We will establish a state of the art of how French academics approach these issues; issues which have led us to examine 'the normalised city' vs its 'interstitial margins', its constants/variables. To illustrate this we present two case studies based on our fieldwork, which reveals that the existence of an urban continuum should also be questioned in light of immigrants' social realities, including their ability or inability to access healthcare services. For this purpose, we will analyse two local initiatives: one related to a specific sector of public action (mother-child-care); one related to living conditions (living in squats). The first one concerns Paris and the institutional organisation of the sector of perinatal healthcare: how does one approach the question of socio-medical services (pregnancy, childbirth, and mother and child care) and that of social services (for newly arrived immigrant women who find themselves in a highly precarious situation) in a specific area: Paris and its suburbs? The second initiative will show how and why local social and medico-social actors are mobilised around housing/living related questions. Through these two examples, we will underline the major issues related to the dynamics of urban environments, taking into account their social and political dimensions.

The nexus between urban living and health in France: the effects of precarity on immigrants' access to healthcare

The subject of urban health in France-just as in other industrialized countries-has been widely investigated and described [START_REF] Bouchayer | Trajectoires sociales et inégalités: recherches sur les conditions de vie[END_REF][START_REF] Chauvin | Santé et recours aux soins des populations vulnérables[END_REF][START_REF] Fassin | Les figures urbaines de la santé publique: enquête sur des expériences locales[END_REF]Marmot and Wilkinson, 2005;[START_REF] Townsend | Deprivation[END_REF][START_REF] Townsend | The International Analysis of Poverty[END_REF][START_REF] Vallée | Les disparités spatiales de santé en ville: l'exemple de Vientiane (Laos)[END_REF]. Studies have shown the differences in mortality or morbidity rates between rich and poor populations for example. However, social and economic indicators appear to be limited in their ability to explain those differences and in their potential as levers for change, as they do not take into account the individual level (how living conditions are experienced effectively and emotionally) and collective responsibilities ("new" social determinants of health such as phenomena of social exclusion that characterize processes of precarisation, inclusion/exclusion in the sphere of employment, social integration, psycho-social characteristics of individuals or family composition and dynamics). Let us emphasize, furthermore, that people experiencing these social and economic conditions cannot be excluded from the scope of public policies, which, as is implied by the principles underlying the welfare state, must aim to reduce inequalities.

France has adopted several laws and mechanisms to combat poverty, precarity, and exclusion. These mechanisms involve various partnerships between the state, public or semipublic organisations, healthcare centres and professionals, local authorities, institutional associations and various charities [START_REF] Labbe | Un indicateur de mesure de la précarité et de la "santé sociale": le score EPICES. L'expérience des Centres d'examens de santé de l'Assurancemaladie[END_REF], which mostly involve the sector of sociomedical services. Precarity is defined by J. Wrezinski (1987, p. 6) as: the absence of one or more of the forms of security, particularly employment, which enable individuals and their families to meet their professional, familial or social obligations and enjoy their fundamental rights. The resulting insecurity maybe more or less extensive and have more or less serious and permanent consequences. It leads to extreme poverty when it affects several areas of existence and becomes persistent, and jeopardizes a person's chances of re-assuming his/her responsibilities and regaining his/her rights by him/herself, in the foreseeable future. This definition illustrates the importance of considering a person's environment as having an impact on his/her well-being and therefore state of health.

Precarity affects various areas of existence, and differs from poverty and social inequalities in health in that precarity involves no social gradient, whereas poverty involves a gradual process of downward social mobility in which individuals or families find themselves due to an accumulation of unfavorable factors. [START_REF] Townsend | Deprivation[END_REF] and [START_REF] Wrezinski | Grande pauvreté et précarité économique et sociale, Rapport présenté au nom du Conseil Economique et Social[END_REF] examined these aspects more closely by defining the EPICES score, which is now used in the field of public health and by French researchers specialized in spatial epidemiology, in order to identify and gain a better understanding of healthcare inequalities as they are experienced by individuals in their social worlds. Individuals in a situation of precarity have a higher incidence of more advanced stages of diseases, particularly homeless people and undocumented immigrants.

Spatial approaches to precarity help to grasp differences between territories and to identify populations who experience healthcare inequalities and are therefore victims of injustice: studying poverty or precarity always amounts to identifying situations perceived as unfair in a given context. Cases of poverty correspond to a particularly unacceptable degree of inequality between those at the bottom of the social scale and the rest of the population concerned. One's relationship to norms is therefore fundamental. In a society, like ours, which strives for some form of social justice and equity, situations of poverty are even more difficult to tolerate. They are associated with, among other things, ills that are perceived as those of a bygone era (inadequate housing conditions, malnutrition, difficult access to healthcare etc.), which immediately places people identified as poor in a humiliating position [START_REF] Zaepfel | Démo-géographie de la précarité et de la pauvreté[END_REF].

The connection between urban environments and the presence of immigrants raises many questions for social sciences, particularly for those that focus on the categorisations of populations, on administrative measures implemented to facilitate or prevent immigration in France and Europe, and on the body of knowledge and competencies used to address migrants' needs. Recent trends in the immigration landscape have prompted us to reframe academic thinking on the question of cities and immigration: recent arrivals of refugees/exiles/immigrants/asylum seekers have been accompanied by the re-emergence of undesirable urban forms inhabited by populations who, by extension, are also considered "undesirable" (Agier 2010, p. 4): 'camps, squatter camps, shanty towns, insalubrious housing' … 'Calais, La Chapelle (Paris), La Poterie (Rennes)' … 'refuge-cities, frontier-cities, crossroad-cities', places in which immigrants concentrate but which are often the types of places we thought had disappeared from European cities.

Since the implementation, between the end of the Second World War and the early-1970s, of measures to eradicate shanty towns, these types of informal settlements have had a stigmatising effect on the people living in them and their existence has been considered as inappropriate in welfare state countries in which people facing housing precarity are supposed to be given access to collective housing programmes. Thus, the recent re-emergence of informal settlements and slums, and more specifically, their high visibility in urban public spaces has reawakened a kind of "national nightmare" combining extreme poverty, economic deliquescence, rising numbers of people in situations of exclusion, particularly among immigrants.

Researchers interested in the field of immigrant integration services pay particular attention to the health aspects of the type of housing, in which immigrants live, particularly in urban areas: Indeed the health and safety argument is often used to legitimise the expulsion of people and is therefore not always useful for initiating constructive debates on the type of actions that should be implemented in order to give populations living in squatter camps access to healthcare [START_REF] Bergeon | Être migrant et vivre en squat. L'EspacePolitique[END_REF]. Furthermore, the notion that the increase of immigration flows is due to the existence of a healthcare system that is open to all regardless of national origin is largely questionable [START_REF] Carde | Quinzeans de réforme de l'accès à unecouverturemaladie des sans-papiers: de l'Aidesociale aux politiquesd'immigration[END_REF]. France adheres to the principle of 'universalism', in which each and every citizen has universal access to the same fundamental rights regardless of race, gender, religion or nationality and 'could be said to hold one of the most liberal and progressive healthcare systems in the world' (Larchanché 2012, p. 858).

Thus, French institutions are governed by two principles enshrined in the constitution: (1) the Republic is one and indivisible and citizens should therefore not be categorised into distinct groups on the basis of race or ethnicity (2) public policies are guided by a strong sense of equality in the national territory and in each territorial unit that composes it [START_REF] Hoyez | Socio-spatial dimensions of healthcare for newly-arrived migrants[END_REF]). However, the imperative of controlling immigration-in France and other European countries-collides with the imperative of universal access to fundamental rights for immigrants. This generates different processes of discrimination (immigrants are for example more often excluded from health insurance coverage) as well as a tendency towards differentiation in the practices of healthcare professionals who find themselves having to 'do something at all costs' in a hurry to place immigrants in the mainstream healthcare system. This is reflected, in the field, by the wide range of healthcare and social care initiatives intended specifically for immigrants.

Beyond being a question of 'public nature', the question of where immigrants who have come to France live has become one of an 'urban nature': these places have to be incorporated into the 'life cycle' of cities, and into the continuity of immigrants' healthcare trajectories. They represent the exact opposite of the 'sustainable city', as defined by public policy objectives, in that they are places of exception, exclusion and extra-territoriality (Agier 2016)1 , places characterised by living conditions unworthy of human habitation. They are places that are difficult to integrate into other public spaces; they are interstitial spaces that escape the city's institutional apparatus [START_REF] Agier | Managing the Undesirables[END_REF][START_REF] Agier | Paris refuge : Habiter les interstices[END_REF]). However, an analysis at micro level shows that these places are fully part of people's lives: as places of passage or as places of settlement, albeit short-term, they allow for some forms of socialisation to develop or offer their inhabitants the possibility of being connected to the mainstream system; but this is only possible if the social and institutional actors do not dissociate the place from its inhabitants [START_REF] Bergeon | Être migrant et vivre en squat. L'EspacePolitique[END_REF].

In this context, the question arises of immigrants' access to the city in all its dimensions, and more specifically two of them: housing and other resources present in the city (here we will more specifically examine health resources). In order to better understand the current situation in France, it is therefore important to focus on the local effects of these issues on the way immigrants are received (what places and networks are set up to help immigrants access the resources of the city?), and to take into account the process of integrating immigrants in the city (what place are they given in the city, whether in common or specific urban spaces?).

Local healthcare initiatives:

The example of a mother-child-care network in the Paris area.

The question of the high levels of poverty and precarity among certain population groups arises acutely in the Ile-de-France region (whose capital is Paris) where most of the immigrant population lives. To cope with situations of growing inequalities in the urban context, some initiatives are being undertaken at the local level. Pregnant women and/or mothers with young children who do not have housing are the object of various initiatives, especially in the North of Paris: in 2006, the SOLIPAM network (SOLidaritéPArisMaman -'Paris Mother Solidarity') was formed as a public sector initiative to help better coordinate the medical and social dimensions-generally disconnected-of the care services provided to women living in highly precarious conditions. In parallel, in 2007, another network was formed in the North of Paris, with the aim of bringing together the hospitals with similar patient profiles; since 2013, this network has been extended to cover the whole Paris region (implying that more healthcare actors have recognized the network's usefulness.) All these initiatives seek to better coordinate the various professionals, to better communicate with and better understand the populations that they serve, in order to improve their healthcare situations. Healthcare professionals took it upon themselves to create this network, after observing that their patients were experiencing extreme difficulties and realizing that it was imperative to take some specific actions to prevent them from foregoing healthcare. This indicates that an unprecedented crisis is arising in the French public healthcare system, which until recently was praised worldwide for being guided by the principle of universalism. This crisis results in a specific institutional positioning, an 'inbetween' where healthcare professionals from the public sector are pushed to create private organizations to meet the healthcare needs of all, especially immigrants.

(insert fig 1, with legend: Reception desk at a shelter center in Paris. Conceived as a place where to welcome and offer spaces for discussions, the office offers chidren facilities and a professional interpretor to interact with families).

The SOLIPAM network was originally formed as a non-profit medical organisation whose purpose was to better coordinate the healthcare services provided to pregnant women living in situations of extreme precarity. The network brings together medical and social professionals in the Ile-de-France region who care for this population. The network is intended to serve as a cross-organisational tool for coordinating and facilitating the activities of structures and actors involved in providing healthcare and social assistance to those pregnant women, and for ensuring that adequate follow up care is provided to them. Furthermore, the network also seeks to raise awareness among, and train medical, social and institutional professionals. The Regional Health Agency (Agence régionale de santé) funds the SOLIPAM network because it considers that this network contributes to ensuring healthcare "continuity and quality". SOLIPAM aims to provide women living in extreme precarity with more comprehensive and more localized healthcare, but also to implement actions in order the help those women gain autonomy as well as stability in their living situations. But achieving this objective is dependent on the concrete ability to ensure continuity in the follow-up process.

Indeed, when health professional partners involved in the network encounter a woman in a situation of extreme precarity, they contact SOLIPAM to apply for the enrolment of the patient in the scheme. If the needs of a woman can effectively be met by SOLIPAM, and if the patient herself accepts the assistance offered by the network, she is contacted to set up an 'inclusion interview'. The interviews, generally conducted face-to-face (sometimes over the phone), consist in a medical check-up (performed by a midwife) or in a social interview (performed by a social worker)-even though, once enrolled, the patient will always be followed up by a team made of a midwife and a social worker. Once the patient is enrolled in the programme, this team works in collaboration with other professionals in the social and medical fields to ensure that comprehensive and coherent care is provided to the patient during her pregnancy (particularly around core issues such as housing, access to welfare benefits, coordination of prenatal and infant care until the child reaches the age of 3 months).

By the time the mothers are supposed to leave the network (three months after the birth of their baby), they are supposed to have gained autonomy; but not all of them have been incorporated in the national mainstream system. This can be due to the complexity of their administrative situation, to the fact that many of them have not yet secured housing and their administrative situations still uncertain. The limitations of these transversal measures, in time and space, quickly become clear.

Yet, SOLIPAM has developed an experimental scheme ('support scheme') to further assist women who cannot apply for medical or social follow-up services (this is the case of undocumented immigrant women): this helps to facilitate access to healthcare benefits and opening of health rights, and to other existing schemes, etc. This initiative is supported by both public and private funds (FondationSanofiEspoir). The need for private funds to support this type of initiative, and more broadly, the very existence of private organizations dedicated to providing assistance to a population living, locally (historically in the North of Paris), in conditions of precarity raises the question of the differential treatment of certain population groups by the State, and of the latter's disengagement from healthcare and social issues affecting parts of the urban population. The network was then extended to cover the whole Paris region (Solidarité Paris Maman - Ile de France). This regionalisation is taking place as part of the development of partnerships in healthcare networks, particularly in the perinatal healthcare networks of the public sector and charitable associations (working in the social, cultural and psychosocial sectors)' (Activity report, 2015).

Given the migratory context in the Paris region, immigrant pregnant women account for between 80 and 90% of the total number of women enrolled in the programme. For them, and for the network, housing is a major question. Indeed, a recent study (Rietsche 2014) underlines that at the time of their enrolment in the programme, women either rely on emergency housing (N=488) or are given shelter by third parties (N=318). The study also shows a decrease (-80%) in the use of makeshift accommodation by women, once they have left the maternity ward and receive post-natal care from the network, and a decrease in the use of housing provided by third parties (-50%), whereas the use of emergency housing, of accommodation in social centres and of social or private housing has increased by 5.5%, 119%, and 29% respectively. This tends to reveal at what stage the issue of housing becomes central for these women, not only in terms of basic housing comfort and safety but also in terms of medical follow-up and access to healthcare benefits.

The coordination activities of the network seem to have an impact on the housing situations of those women, as well as on their access to welfare benefits. In France, the type of residence permit (granted by the authorities) plays a central role in the type of healthcare and social services these women are entitled to. About two thirds of the women do not have any healthcare coverage at the time of their enrolment in the network; 15% are waiting for their application for residency to be processed, only 6% have a valid residence permit, 2% are waiting to know what type of residence title they will be applying for. It also should be noted that a large majority of these women have temporary residence permits (3 months to 3 years) and that each change in their status has an impact on their healthcare insurance. Moreover, there are many cases of women who do not take up their welfare benefits (about a quarter of the women are eligible for social welfare benefits but do not have access to them because they have not applied for them, either for economic reasons, or because they think they are not entitled to them.) (insert fig. 2, with legend : "Temporary housing solution for immigrant women in 2017.

Behind the fence (at the back of the picture) figure freight rails desserving Paris' surburbs.") (insert fig. 3, with legend: "At the entrance of the health office in a temporary housing unit for immigrant women in Paris' surburbs in 2017".)

The evolution of SOLIPAM's actions must be analyzed from the point of view of public healthcare professionals who operate in a difficult context due to the exponential increase in the number of women in perinatal stages living in extreme precarity. This Parisbased network had to be extended to include other areas around Paris due to a double-sided situation. In effect, women in highly precarious situations are not all located within Paris proper; indeed many of them live in other areas outside Paris in equally precarious conditions.

The work carried out by the network has gradually been recognized throughout the whole region which has contributed to legitimizing the actions undertaken by an increasing number of professionals (in relation to coordination, training, advocacy, etc). At the same time, the network has great difficulty coordinating the medical care provided to patients at the local level. Paris is characterized by a serious shortage of housing, and there seems to be no room for debates on the possibility of facilitating access to housing for women living in highly precarious conditions and/or waiting for residence permits. Consequently, these women relocate mostly to other areas in the Paris region, which implies a necessity for collaboration at the regional level between professionals of the healthcare sector. Finally, in terms of research, this example brings to light the importance of taking into account the sociohistorical and institutional contexts in urban areas, in order to better analyze the life trajectories of immigrants. The urban context highlights how a large number of actors work together thanks to a network, even though the latter faces severe budgetary limitations. This network addresses a major public health issue (perinatal care for women in precarious situations) and plays a central role in coordinating actions at the level of the Paris region, and therefore provides a good illustration of professional cultures, and of inter-disciplinary and inter-sector work such as it ought to be organized. This research study shows how partnerships in the healthcare sector consider immigrants, and highlights the importance of coordinating medical services in a more holistic manner, that is to say by taking into account immigrants' housing realities and their residential status.

Local actions in 'squats and slums'

The issue of housing for immigrants in France generates much heat in the media, which largely cover operations to evacuate illegally occupied sites in French cities or border crossing points. Moreover, a large number of immigrants live in situations of residential precarity and poor housing conditions, such as in squats or camps. Today, these forms of 'housing' sometimes seem to be the only way for recently arrived immigrants to put a roof over their head: 'living in a squat is better than living on the street' is a comment often heard in the field. Places such as squats are often characterised by precariousness and insalubrity. This is often used by the local authorities to justify the evacuation of people from those places. These arguments are in keeping with the hygiene-related considerations put forward in the 1960s when measures were implemented to eradicate places of insalubrious housing and shantytowns. These precarious living spaces were then considered as hot spots in the 'sick city', as Fijalkow (2013, p. 137) puts it, with eradication being seen as the solution to prevent 'the spread of infection throughout the country'. The reappearance of this type of space has awakened the collective memory; and squats, because of their characteristics (unfit for living in, unsafe, lack of waste management, lack of access to water, electricity, fuel and communication, overpopulation), are associated with strongly negative representations that have to be deconstructed [START_REF] Bergeon | Être migrant et vivre en squat. L'EspacePolitique[END_REF]. Moreover, there is a persistent shortcut linking immigrants (especially those living in illegal situations and precarious places) to a 'problematic' population whose presence is illegitimate in the local area. These representations fail to consider the daily problems immigrants face and deny their difficult life realities.

(insert fig 4, with legend : " "Roofs with no people. For people without a roof: requisition!", translation of the slogan of an association's banner occupying an empty church sheltering approximately 200 immigrants in Rennes in 2015 ") Analysing health and access to healthcare through the prism of residential precariousness requires a threefold approach: (1) that of migrants (the difficulties they encounter in accessing/understanding the healthcare system and being cared for on a daily basis); (2) that of healthcare professionals and voluntary organisations (responding to the needs of a vulnerable population sometimes difficult to access and for whom health is not a priority given the housing and administrative difficulties they are confronted with); and (3) that of local authorities (who use the health and safety argument to put pressure on the residents to vacate the premises). Thus, we conducted fieldwork in various squats in the cities of Rennes and Poitiers (France), to try to understand how a squat works, and to analyze the healthcare issues facing individuals living in precarity, in relation with their daily living environment. Housing precarity encompasses several dimensions: lack of housing, difficulties in accessing and maintaining housing, lack of comfort, insalubrity, forced mobility (Rapport, Abbé and Pierre 1995;[START_REF] Dietrich-Ragon | Tensionsautour des procéduresliées à l'insalubrité. L'exemple du saturnisme infantile[END_REF][START_REF] Fijalkow | L'hygiénisme au chevet de la villemalade[END_REF]. All these aspects of squatting have a direct impact on the squatters' state of health, and a detrimental effect on patients' adherence to treatments prescribed for specific conditions.

Most of the squats we investigated in Rennes and Poitiers had no running water, no electricity nor heating at the very beginning of the occupation. This was the case, for example, in the Squat of La Poterie in Rennes, until December 2016. Like many other squats in Rennes, La Poterie is a very organised and 'regulated' place. To help ensure the best possible functioning of the collective dwelling, a 'Squat Council' composed of representatives of each migrant community has been established. Every two weeks, they come together with the members of the support association for homeless immigrants, to take stock of the difficulties encountered by the residents. As part of our research, we attended those meetings on a regular basis and observed the exchanges, negotiations or tensions between the inhabitants. In December, with winter well on its way, the issue of heating was at the centre of the discussions. The members of the association were highly invested in the running of the collective dwelling and it was decided that the installation of the heating equipment would be financed, in part by the residents (according to their means) and in part by the association. Basic comfort needs are identified and prioritized: making the premises habitable is of paramount importance for the residents, who also work together to fight against insalubrity in the collective dwelling. The layout of the space, the population density in the squat and the quality of the dwelling also affect the implementation and efficiency of the care processes for physically impaired immigrants.

Besides physical health problems, a number of residents suffer from psychological disorders related to the context and conditions in which their migration took place, on the one hand, and to the uncertainty of their housing situation, on the other hand. Many of the immigrants we met told us about the anguish they experience in relation to their administrative status in France and their housing situation. The threat of being evicted is a constant source of stress for the families and gives rise to symptoms such as insomnia, anxiety attacks or night breathing difficulties. This stress is further amplified by their daily struggle, in a restrictive political context, to obtain residential rights, housing, and access to healthcare.

In the case of the immigrants we met, it is in fact precarity in its various manifestations, which compromises the efficiency of social care and healthcare. The accumulation of administrative and/or housing obstacles maintains individuals into situations of extreme precarity, which forces them to make day-to-day survival choices rather than medium-or long-term decisions. In the interviews we conducted, it became clear that, for these immigrants, their residential status and housing situation had priority over health issues.

And that is one of the problems facing health professionals. Uncertainty about one's housing situation inevitably results in a lack of continuity and stability in care processes. Thus, the evacuation of a squat can result in the "loss" of a patient for a healthcare professional, who therefore can no longer follow up on his/her health status. Eviction can have a significant impact on healthcare in that it can put an end to the professional relationship between the patient and the healthcare provider; a relationship which was often established before or while the patient was living in the squat. Once a patient has consulted a healthcare professional and trust is established between them, the latter often becomes a prominent figure in the daily life of the immigrant. A patient's care trajectory depends on the squat's temporality and life.

In the course of our fieldwork, particularly during the observation phases, we identified three stages in the life cycle of a squat, stages during which targeted actions can be implemented, particularly around healthcare. The first stage is the 'establishment of the squatter dwelling': this is when the future inhabitants settle down and familiarize themselves with their new living space. The priority is then to familiarize and position oneself in the space, to start negotiations about the sharing of the space in the dwelling. Thus, this is a time of excitement, albeit brief. The second stage in the life of the squat is when the occupants have settled and each occupant has his/her own space within the dwelling, and the squat is stabilised. It is precisely at this point that social, legal, or health actions can be implemented.

Immigrants and associations know that once the squat is established, eviction cannot take place until a lengthy court process has been completed. In this regard, this phase is a 'period of calm' and housing stability during which residents can pay more attention to their health and professionals can identify health issues requiring urgent attention and treatment-in particular in the case of people with physical or mental disabilities-and follow up their patients' conditions more easily. Healthcare plans can be put in place for people suffering from serious pathologies, and monitoring becomes easier. Housing stability also facilitates the setting up of 'care routines' for individuals who could not care for their health when they were homeless. The squat is a dynamic place, a 'micro-society', the moves in and out set the tempo for the life of the squat. However, the population density in the dwelling increases continuously, which generates tensions between the residents, less peaceful cohabitation and conflicts related to the use of water, electricity, fuel and communication facilities. This gradual emergence of tension marks the onset of the squat's last stage of life, before its evacuation. The local authorities then put forward the increasing insalubrity related to the overpopulation in the dwelling to legitimise its evacuation. The residents, aware of this development, start experiencing growing psychological distress, and healthcare becomes, once again, secondary. Following the residents' eviction, their trajectories change: some immigrants move to another squat in the city, others access temporary accommodation, while others are displaced to other cities or countries. In all cases, the routines and measures implemented while they were living in the squat are disrupted by the eviction and subsequent move to other squats, cities or countries. Housing precarity, beyond its material aspects, has a considerable impact on individuals' ability to care for their health and on the ability of healthcare professionals to follow up on their patients. Facilitating people's access to healthcare constitutes an important part of the missions of social workers. Associations play a key role in helping immigrants access information about their rights, and represent, for healthcare professionals indispensable intermediaries between the population living in precarious housing conditions and themselves. Despite being the subject of media coverage, squats remain invisible urban places which healthcare professionals seldom invest in 'spontaneously'. In the fieldwork we conducted in Poitiers, a partnership has been set up between collectives and associations such as LA CIMADE in order to connect populations and healthcare professionals. The first contacts are made via the social workers, who visit the squats' residents and assist the immigrants in their administrative procedures (i.e. in the process involved in obtaining residential rights and in gaining access to housing). Once immigrants are granted access to welfare benefits, appointments are made with doctors in a 'mainstream" healthcare structure or in an organization that provides support for people living in very precarious situations. Various types of healthcare organizations are involved in the care provided to people living in precarity. But we have found that immigrants tend to use specific support networks more than mainstream healthcare structures [START_REF] Hoyez | L'accès aux soins des migrants en France et la "culture de l'initiative locale[END_REF]: our fieldwork revealed that networking initiatives are common in the two regions studied. In all cases, strong relations develop between associations and health professionals who decide, on the type of care and treatment that should be administered to patients 'with specificities', in a political context that is unfavorable to differentiation. The precarious conditions in which those immigrants live sometimes exacerbate an already vulnerable and fragile state of health. Living in a squat presents health risks (insalubrity, obstacles in the setting up of care pathways, etc.) at the physical and psychological levels. Thus, the combined effects of precarity further complicate the work carried out by healthcare professionals.

Precarity forces immigrants to prioritize some basic needs over others, and addressing immediate needs related to one's legal residence rights and housing situation often takes priority over health-related needs. The constant need for health professionals to adapt to patients with such unstable and fragmented life trajectories raises the broader question of the effectiveness of the healthcare system in helping individuals in situations of precarity.

Conclusion

A city's mission has, historically, been to provide services to and promote the integration of all its residents. What does the current situation in France show us in this respect? Taking into account, in urban studies, the effects of precarity on housing and healthcare helps to better understand the segregation processes developing in urban spaces, especially in the 'interstitial urban spaces' (either public or private). This analysis has enabled us to highlight the actions implemented by civic and institutional actors to counter segregation and to respond with a focus on urbanity. The question raised by the problems encountered by immigrants living in urban areas is not merely a question of local policy, but requires that urban governance be considered beyond the borders of municipalities (as the Solipam network shows).

We observe an increasing specialization of urban areas: the places to which immigrants are relegated and those to which they must go to receive medical care are becoming increasingly specific and differentiated from other spaces in the city. Spaces and services are supposed to exist in Europe to help immigrants become integrated into the host city. Yet there exist a large number of initiatives undertaken at the regional level by civic actors. The examples we have discussed here have enabled us to underline the fundamental aspects of the relations between social, medico-social and medical actors established in a territory around immigrants' condition of living or specific events occurring during life time.

It should be noted that these networks are constantly working to raise funds (especially in order to be able to employ new social workers and midwives), while the number of immigrants included each year in these schemes is increasing. Another important aspect concerns the autonomy of immigrants and their families. Measures should be implemented to promote the autonomy of immigrants and their family once their rights have been acquired and once the first medical appointments have been made, and to inform them about the functioning of the various mainstream healthcare structures.

In this chapter, we have sought to outline the indefectible link between housing and health and to underline that in urban spaces, and have hightlighted that these links should be examined by taking into account immigrants' individual situations. Researchers have the ability to highlight the visible degradation of the living conditions of immigrant populations in urban spaces while taking into account the contexts in which healthcare professionals work as well as the emergence of precarisation processes among populations. Furthermore, our examples show that healthcare professionals and social workers face serious difficulties on several levels: to understand the living conditions of immigrants (some professionals should go to the squat to gain a better understanding of the squatter's daily living conditions), to communicate with immigrant patients (problems related to language complicate exchanges

(

  insert fig 5, with legend : "A social gathering at the squat 'La Poterie' in Rennes, sheltering 200 to 300 immigrants in Rennes in 2016-2017")

Michel Agier replaces the « 3E » of the sustainable city (economic, ecologic, ethic) by the « 3E » of indignity (exception, exclusion, extra-territoriality).

and call for a more regular use of interpreters) and finally to take into consideration the life trajectory of each immigrant when addressing his/her illnesses or health issues.


Anne-Cécile Hoyez

Clélia Gasquet-Blanchard

Photographer. François Lepage

Bodies at the crossroads between immigration and health

, on healthcare access for immigrants in Europe, we would like to relate an anecdote which happened, in the field, to one author of this chapter. This anecdote tends to indicate that there are times when research on health care and the body can impact the researcher in a way that possibly prompts him/her to approach his/her object of study with more humanity. The researcher in question had made an appointment a few days before to conduct an interview with the director of a support centre for immigrants. As she arrived at the centre on the agreed date and time, the researcher, who was eight months pregnant at the time, was greeted as follows:

« Oh…but it's you! my colleague told me "there's a pregnant woman here who wants to see you". I got worried!!! I thought for a minute that it was another pregnant woman from Eastern Europe who'd come here to give birth! [she laughs]" (Director of a support centre for immigrants, Rennes, June 2008) At this time when the researcher first met the director in question, she had just begun her fieldwork. The research involved immersing herself in social welfare centres with a view to gaining a better understanding of the conditions of access to health care among immigrants in France and focusing attention both on the immigrants themselves and on the working conditions of professionals and volunteers operating in various support centres. That day, the director's reaction to the researcher's (pregnant) body is indicative of stereotypical representations of all kinds applied cumulatively by professionals to immigrants and which would not normally be revealed in the context of an interview. In this particular place -the support centre for immigrants -a pregnant, white woman could only be an Eastern European immigrant; the researcher embodies the figure of female immigration in France. Clearly, beyond the stereotypes and ethical questions raised by this situation (which it is not our place to judge here), this fieldwork prompted an indepth reflection on how we should conduct our research: should we concentrate

primarily on the professionals' "deficiencies", which are representative of the difficulties they experience on a daily basis in managing the humanitarian emergencies and difficult situations that hinder their work and make it more challenging? Should we bring to light and analyse the identity labels applied to immigrants in those support and healthcare centres? It was above all the researcher's physical appearance which caused the director to assume she was an East European migrant. This leads us straight to the question of the link between immigration and health in Europe today: What causes carers and social workers to "fear" the arrival of immigrants, especially pregnant immigrant women? Is it the fear of an uncontrollable "wave of immigration"? Is it the fear that this would place an additional financial burden on public services? Is it the anxiety about the growing number of very complex situations in which individuals face a combination of challenges such as precarity, exile, poverty, uncertainty concerning their legal status, and the prospect of a growing family? Is it a combination of all three factors? At the same time, professionals in the field express significant concerns and conflicts related to the impact of restrictive public policies, to the increasingly tight control of public spending and to the management of populations (including immigrants).

In Europe, contexts of immigration tend to be analysed in terms of "crisis", managed in a temporality of urgency in different parts of the territory. At the same time, the public sector itself, including health and social welfare, is in "crisis" as a result of major economic restructuring marked by severe budgetary restrictions and sector liberalization. But are we dealing with "immigration crisis" or an "immigrant reception crisis"? Who or what is actually posing a threat to the healthcare and social welfare systems? Is it the arrival of immigrants or the neoliberal economic policies and programmes? Moreover, we know from research on migration, that the routes used by immigrants to reach Europe are increasingly dangerous; a significant number of NGOs report an increasing number of deaths at Europe's borders as well as an intensification of health problems among recently arrived immigrants to European countries. In addition, several researchers have highlighted the harmful consequences for health and well-being of the precarious living conditions of newcomers once in Europe [START_REF] Thomas | Handbook of Migration and Health[END_REF].

However, as Didier [START_REF] Fassin | Quand le corps fait loi. La raison humanitaire dans les procédures de régularisation des étrangers (When the body makes the law: Humanitarian rationale in the legalisation of foreigners)[END_REF] points out, scholars should bear in mind the fact that, in relation to these alarming finding, an immigrant's body is not merely a passive vector or recipient of disease. In this regard, part of our work as researchers is to examine (1) what is involved when dealing with the body, disease and suffering and (2) how, in our social worlds, immigrants' bodies serve as a marker of difference.

In this chapter, we will explore the complexity of the situations which, we, as health geographers specialized in migration issues, are confronted with by gradually shifting from a social geography to a geo-humanities approach. In our research, we aimed at stepping away from "describing" with words and at showing human conditions the way they are in places. In this way, we wanted to connect our knowledge as social scientists with humanities disciplines. We chose to develop this throught arts, for their potential in creativity and engagement, and especially with photography. Using an approach based on the human body, what can we learn about social inequalities and their management by nation states? What do we know about the healthcare pathways of immigrants and about their access to health care in their everyday lives [START_REF] Hoyez | Socio-spatial dimensions of healthcare for newly arrived migrants[END_REF]? What method would make it possible to examine and analyse these phenomena while taking greater account of the human dimension in the processing of scientific information?

This chapter is the result of a research project which investigated access to health care for immigrants in France, in which we took into account the situations of both ill people and non-ill people whose precarious living conditions impact their health or whose life events require that they receive medical and social attention, as in the case of pregnancy, to which we will pay particular attention here. In a context where migratory pathways are stretching (both in time and space), and where the number of female immigrants is growing, we explore how women manage to empower themselves, to overcome the identity labels applied to them throughout their journey, and which, for the most part, impact them negatively. Within their life histories and immigration pathways, it is their bodies that are at stake. In the first step of this chapter, we illustrate how immigrant women reappropriate their own bodies and analyse their place, as socially constructed objects, in constituting the social space in which carers, social workers, women themselves, their relatives and families are shaped and emerge together. In a second step, we expand our reflections on the subject of immigration as social geographers by adding a new path through photography to our 'conventional' qualitative methodological tools in order to explore emotions and body concerns.

Immigrant women's bodies in a context of restrictive policies

The pregnant women we met in the course of our research have very different histories: some fled a country at war, both alone or with their male partner or family and may have either joined relatives in France or had no contacts in this country, France not necessarily having been their intended destination country initially. Other women moved to join a spouse who had already come to work in France while others came to pursue higher education. Whatever the socioeconomic context in which they found themselves, their individual migration is 4 undertaken as part of a collective destiny shared with parents or even children left behind or close ones scattered in different countries. All mention the impact on their everyday experiences and affects of the spatial dimension of this situation of, on the one hand, separation from part or all of their families, and/or, on the other, of their moving closer to other family members, the coming together of siblings who had previously been living far from one another or the development of strong friendships in the host country). These experiences of distance and mobility mark each stage of their existence.

Migration journeys can be long, costly, dangerous and punctuated by a varying number of short stays in cities or other places that serve as more or less chosen stages. During these journey stages, they may have been subjected to sexual violence through rape, kidnapping, domestic slavery, excision, insults or discriminatory attitudes and these are experiences unlikely to emerge and difficult to identify in an interview situation. This raises the question of how we, as researchers and likely the umpteenth people asking for testimonies, intrude into the most troubled realms of these immigrants. Moreover, once women arrive in France, they face other gender-related problems in terms of the highly fragmented labour market which offers few job opportunities for them; even those who are hired are always, initially at least, given underqualified jobs [START_REF] Schmoll | Le corps des autres dans l'Europe des frontières[END_REF].

However, amidst the variety of female migratory trajectories, one specific figure stands out as being both sometimes particularly exposed, and sometimes particularly protected compared with others, that of pregnant women or women with children. The stages and events that punctuate the trajectories of pregnant women can be analysed by focusing our attention on their body and its transformations as well as on their emotions.

Those women are in an ambivalent position. They are more likely to be exposed to gender-based violence or to processes of differentiation or social downgrading but they are also the object of specific policies, such as those for family protection and child protection, whereby they can receive some welfare benefits to which men are not entitled. Illegal immigrant women -these "precarious subjects" who are not recognized by the system (Butler, 2009) -are more likely to fall victim to differentiation or discrimination processes, or even to be excluded from certain areas of the social world, especially in public spaces and in professional worlds [START_REF] Fournand | La femme enceinte, la jeune mère et son bébé dans l'espace public[END_REF]. From an intersectional point of view, they are, more than other women, subjected to domination through racial/ethnic, gender and social stereotyping. However, pregnancy strongly impacts the conditions in which these women live. Pregnancy gives these women access to common rights, which will influence their living conditions while they are pregnant and throughout their child's infancy [START_REF] Virole | Devenir mère, devenir sujet ? Parcours de femmes enceintes sans-papiers en France. Genre, sexualité & société[END_REF]. Women themselves must apply for those services, but nonetheless, the support they can then access is designed to empower them and will help them to be recognized by healthcare professionals and institutions as subjects with rights in ways not the case before pregnancy. Through these support programmes, pregnant women benefit from regular pre-and post-natal care services, which many of them had never experienced in their country of origin. It is our responsibility, as researchers, to examine the reasons and processes through which pregnancy and motherhood help women be recognized as subjects with rights, and to emphasize that women's pregnant bodies and infants can help them to assert themselves in their lives as women.

The migratory experiences of these immigrant women, as they related to them us, gave rise to many discussions about opportunities to change their circumstances. Their stories are marked by various shifts and major changes in their situation that occurred over a relatively short period of time when they became pregnant. Such is the case of Milly who, now that she was pregnant, knew that she would be given priority on the waiting list for housing and would have stable accommodation during the last two trimesters of her pregnancy and the first months of her child's life:

For me it's okay now, with the baby, I'm going to be entitled to housing when I get out of here. But what will happen to Ahmed? He is all alone, no child, no housing. It is for him that we must fight now.

She is aware of the fact that her personal, intimate, family event, is, in fact, a social event that marks the end of years of residential precariousnes, during which she, as a single woman, had never had priority on the housing waiting list.

The bodies of these immigrant pregnant women become a place, a geographic level at which to examine and report on individual experiences and on how corporealities are taken into account in institutions. The body is then placed at the core of social, institutional and political issues through control of the migrant body. Obviously, the way in which pregnant immigrant women are treated and cared for is tinged with moral overtones. Indeed, as noted in our introduction to this chapter, pregnant immigrant women can be labelled with derogatory stereotypes. There is a belief, as displayed in the opening vignette, that some of them come to France to give birth in order to take advantage of the supposedly more supportive social welfare system, but nonetheless, whatever happens, most will be helped and supported and, if they are not, public controversy will ensue.

Moreover, the women use a number of techniques that contradict the common notion that, because of their conditions as immigrants living in precarity, they lack any capacity for action [START_REF] Fournand | Le corps des femmes, enjeu géopolitique[END_REF]. For pregnancy follow-ups, ultrasound readings, giving an opinion on the possibility of an epidural, planning to breastfeed or not, feeding a very young child, carrying children, etc., these women have proved very resourceful. The arrival of a child is mostly experienced as a blessing and the descriptions we were given of the mother-child relationship are 6 based on a large variety of emotions and sensitivities, which pleads for a sensitive and humane approach to inequalities and discrimination.

Bodies combining disadvantages: pregnant, undocumented and poor women

Several studies have been conducted about social and health inequalities, particularly those that develop during pregnancy for women living in precarity. Precarity is not the only prism through which the trajectories of pregnant immigrant women are examined, but it is an important part of the realities encountered (see Box 1). Addressing precarity experienced by these women is not just a matter of describing their economic and social living conditions, or of assessing their access to healthcare rights and to stable housing. However, studying these two events (pregnancy and migration) when they occur within the same temporal framework requires that we situate our remarks in this context, so as to better analyse the effects of precarity on pregnancies and their outcomes, to better identify what is universal in the situation of precarity during pregnancy and what turns out to be different for immigrant women.

Box 1: Field data

The NGO Médecins du Monde (2016Monde ( , 2017) ) points out in its recent reports that the precarious administrative situation of women puts them at greater risk: 18.1% are asylum seekers and 52% are undocumented. The pregnant women we met in MdM healthcare centres and their partner clinics have very limited or no access to health care coverage (68%) and consequently to prenatal care (over 40% had no access to prenatal care in 2016, and 58.4% in 2017) and 45.5% of pregnant women do not receive regular prenatal care. Their living conditions have particularly harmful effects on their health: the majority of them indicate that they are living with a third party (55.6%) and it is not known what this type of living arrangement involves. 8.1% are homeless, and 48.4% consider that they live in temporary and unstable accommodation. Finally, women who have received care at an MdM clinic report that they go out as little as possible for fear of being arrested. Thus, the fear of being arrested by the police acts as a further significant obstacle to their access to healthcare in specialized centres.

In the medical field, precarity, for all populations combined, is known to be associated with an increase in pregnancy and neonatal complications and with an increase in the length of hospital stays [START_REF] Gayral-Taminh | Caractéristiques socio-démographiques et risques périnatals des mères en situation de précarité[END_REF]. There is a correlation between precarity and sub-standard or non-existent prenatal care, and therefore the increase in perinatal complications (Lejeune, 2008). As seen in Box 1, women's situation as immigrants can further contribute to the difficulties and vulnerability associated with precarity in general. Several studies conducted in northern countries show that immigrants populations originated from Asia, North African and sub-Saharan Africa have a higher risk of neonatal mortality and of prematurity compared with non-immigrant populations and immigrants of other origins (Gagnon, 2009;Gissler, 2009;[START_REF] Malin | Maternal care and birth outcomes among ethnic minority women in Finland[END_REF]Racape, 2010). In addition, the birth of a child causes significant social, economical and psychological changes that place the mother in an even more vulnerable position, especially if it occurs in a situation of migration (Battaglini et al., 2002b). This is reinforced in the context of violence that currently exists in many of the regions immigrants have to cross in order to get to their destination (Médecins du Monde, 2016, 2017; Report of the Samu Social Observatory, 2017).

The negative effect of precarity aggravates the illnesses that can occur during pregnancy in terms of care through the possibilities for effective and efficient use of the health care system. In France, the National Commission on Child Birth and Health (2014) highlights that women living in precarity use the healthcare system less and later. Several reasons explain this: i) a late initiation of prenatal care involving late diagnosis of pregnancy, fewer prenatal consultations, fewer ultrasounds and so forth due to the daily difficulties encountered by immigrant women living in precarity; difficulties which often prevent women from being aware of or paying attention to the early symptoms of pregnancy; ii) irregular attendance at prenatal care through the difficulties for women in attending all the scheduled appointments or to have additional examinations performed, particularly if this entails attending a different unit other than the clinic they normally attend, due to their poor knowledge of an area in which they have only recently arrived; iii) frequent use of hospital emergency services, given these are the only places immigrant women can identify easily.

These difficulties are among the general factors of disadvantage associated with characteristics of the socio-spatial contexts in which women operate: poor knowledge of the area and of the location of the healthcare facilities; geographical isolation; socio-economic context of the area of residence (Gasquet-Blanchard, Collombier, Parkins, 2018); use of specialized support services; preference for carers who share the same geographic origins or the same language and can advise in favour or against different types of consultation; support provided through personal networks of friends or family who may or may not help them familiarize themselves with healthcare facilities; and, finally, all the characteristics of the person including age at the time of pregnancy, education, income, single parent or not, physical and psychological health (Battaglini, 2002-2). These factors are combined with those that affect immigrant women more specifically including: social (language, support, and presence of the partner, family and friends); financial (the type of financial resources available to the woman); administrative (the type of health insurance, type of residence document). The situation of vulnerability in which women find themselves -mentioned in other studies (Médecins du Monde, 2015) -has proved recurrent, although not systematic, among the women we met.

The women we met experienced, after their pregnancy was confirmed, different changes in their social lives. Some of them mentioned going through marital and family breakups, which often caused them to leave their place of residence. At the same time, others reported developing a closer relationship with their spouse. The social network is the first line of protection against the immediate effects of a marital breakdown, but where networks are geographically dispersed, the women must navigate their pregnancy within a fragmented social world. Even when surrounded by relatives, these women can sometimes be exposed to one or more risks due to their status as isolated immigrants dependant on a defined group of family and acquaintances. For example, the pregnant women who receive medical care from the Paris Samu Social (emergency social services) often report a high level of social of isolation exactly at a time when moral support is essential and which can further hinder their access to healthcare. These risks are combined with the mobility limitations experienced by pregnant women and mothers of small children [START_REF] Fournand | La femme enceinte, la jeune mère et son bébé dans l'espace public[END_REF]. This isolation can be observed through a distance/proximity dialectic. Geographic distance from one's home country can foster proximity with one's compatriots in the host country, a proximity which would not have developed in other circumstances, and which can contribute to the development of new forms of social relationships, or even of new functions in the family, as illustrated by the roles taken on by some fathers; roles they would not have had in their country of origin.

Having moved away from their usual social network, these women find themselves separated from those who would have been able to give them the psychological and practical support they needed as pregnant women, such as a mother, sisters, spouse and friends. They then surround themselves with, and find resources and support among, their new neighbours, compatriots, and caregivers, which enables them to recreate a safe environment for the duration of their pregnancy.

Risk factors also include the difficulties of communication between pregnant immigrant women and carers. These difficulties are not only related to the patient's level of proficiency in the language, but also to the contexts of communication with the medical and social care teams. The information exchanged between the various team members must include not only information about the patient's healthcare history but also about other important dimensions of her life, such as physical and psychological health, social condition, food and housing. These communication difficulties can lead to delays in the provision of care, or to inappropriate treatments, and to a poor understanding or ignorance of the healthcare system. Among pregnant immigrant women, we have found that certain barriers prevent them from receiving optimal health care, which can be reinforced by personal and family-related vulnerabilities that may lead to dysfunctions in the natural birth process and even in the establishment of a bond between parent and child (Davoudian, 2007). Finally, the difficulties linked to the negative stereotypes and representations of pregnant immigrant women applied by health professionals must be taken into account. Negative representations of patients with unstable residence permits can lead to the denial of treatment by carers. More generally, the medical profession has been known to engage in processes of ethnicization or racialization of women, which can lead to inadequate and differential care and, thereby, increase the risks of complications (Sauvegrain, 2017).

Geo-humanities: building a bridge between geographies and art photography to replace women bodies in sensitive contexts

Geographers have for a long time developed approaches for observing and analysing the inter-relations between spatial configurations and social phenomena. Several methodologies are often combined and used to account for those interactions, including approaches borrowed from ethnography and sociology. In our qualitative research, we conducted a large number of in-depth interviews, in situ observations, and collections of visuals, including photographs. Yet, inexperienced in this art form and reduced to shooting photographs in a highspeed continuous mode with our pocket digital devices we collected few visual documents that could be used in publications or that could be given back to participants. However, in 2018, we had the opportunity to collaborate with François Lepage, a photographer and author on immigration issues, and this was just the push we needed to move towards a geo-humanities approach. In parallel with our field observations, which are fairly typical in the field of social geography, we have developed an interest in artistic approaches, and the conversations, experiences and insights they can produce. For a year, while nearly 200 immigrants lived in a squat, which was eventually legalized (Hoyez et al., forthcoming), we conducted surveys and observations among the inhabitants of this place to fully understand the sensitive and everyday aspects of life in a squat and in precarious accommodation. Meanwhile, François Lepage, who for several years has turned his lens towards migration phenomena, set up a photo studio and invited the squat residents to come and have their photos taken whenever they wanted (see Box 2). We worked in parallel with François, interviewing and photographing women. By paying close attention, together, to the faces of the women, men, children, and families who lived in this place, we gradually adopted 10 an artistic approach to our research. These were not the snaps that we captured with our pocket devices, these images were more, said more and produced very different encounters. These 'art' photographs brought something extra to the research. They helped to go beyond the approaches commonly used in the social sciences to examine social and spatial inequalities in healthcare, discriminatory processes affecting immigrant women, their partners and children, or "Frenchstyle" pregnancy care pathways. These photographs bring us face to face with women, men, mothers and fathers of children who pose together proudly. Inevitably, they challenge the descriptive categorizations that we, as researchers, often apply. Could we still justifiably call the people we met "immigrants" in a generic way? No, we could not, because when we look at these photographs, we see, first and foremost, people, inhabitants, whose dwelling occupancy pattern reminds us of the foundations of the Right to the City of H. [START_REF] Lefebvre | Le droit à la ville[END_REF]. The photography and the exchanges between the academic and artistic worlds have placed the human being at the heart of our analysis. This approach repositions emotions and affects in the foreground of research. In going beyond scientific protocols and reintegrating emotions, the photographic process gives pride of place to the reflexivity of researchers and to its impacts on the human sensitivity with which we conduct research work.. The more significant change, however, was that, beyond these frameworks established between researchers and the artist, those people who were photographed intervened as actors in a collaborative process. François Lepage wished not only to "take photos" but also to "give pictures" to the inhabitants. The shots were in fact intended primarily to be distributed to those photographed, with the intention to share something concretely. This posture has distorted the conventional relationship between the photographer and the photographed, shifting it from a relationship of 'observer/observed', in which the act of photographing formally captures a particular moment, to an interactional relationship in which the protagonists are participants without having to answer a question or an order defined a priori. The photographer no longer stands as a professional of the image, but takes on the role of an artist who thwarts the materialist universe of photographs. In the same way, the charitable organisations working with those living in this place indicated to us that the photo studio was part of the 'cultural' coordination organised for the inhabitants in that it was not a project to photograph everyone, but rather a proposal or an opportunity to have a photograph. These, then, are pictures of inhabitants, not just the photos of the photographer. This distinction is important because it emphasises the ambition to make the inhabitants active in their presentation of themselves. They had a total freedom of pose and free choice of the day when they would show up as the studio was set up permanently. Here, photography is not only a social act or a way of meeting in one moment. It is, instead, a process of mutual trust and sharing, across the short, medium and long term, because the photography participates in the identity reconstruction of people, both for themselves and for those who come to see them through the associated photography exhibitions. The process re-humanises identities that the media too often distance and even render invisible.

Box 2: François Lepage presents his photographic approach "In the summer of 2016, I set up a photographic studio in the squat known as "Les Jardins de la Poterie" in Rennes. An ephemeral dwelling in which 170 exiled people lived for a year, half of them children.

At first, people pass by, a little surprised. "What are you doing?"," -Is it compulsory?" They leave and then come back. Alone, or with their families, they walk around the studio, dressed in their Sunday-best and prepared. They assume their own poses.

I lose control of the photo shoot session…I go with the flow… From the very first pictures, I am disturbed. The shot doesn't correspond to the image I had of them. Perhaps I had imagined them "unkempt and threatening" just as they would have been depicted on an anti-foreigner Nazi propaganda poster, or else I've been conditioned to see them that way. Under the flashes, their joy and light shine through. They remind me of Leonard Cohen: "There is a crack, a crack in everything, that's how the light gets in".

This photographic project has led to many encounters. With people from all corners of a planet fragmented by walls and barbed wire; from Mongolia to Congo, from Albania to Chechnya... With associations that give direction to human beings who have lost their bearings (at UTUD -A roof is a right, MRAP and many others...).With social science researchers from the University of Rennes 2 and the Institut d'Études Politiques, who are working on "ephemeral housing""

The people who have been photographed have agreed to use the rendering for public exhibition purposes. All the people agreed, with the exception of one girl who especially wished not to be recognised by her high school classmates. She nevertheless accepted after having discussed with François Lepage who proposed to "veil" the photograph (photo 1).

The total freedom given on the shooting allowed us to probe the desires of use of photography by the inhabitants. In the short term, desires were very varied: the use of a new photo for a Facebook profile (photo 6); the wish to send a photo back to family who have remained in their country of origin; the display of a nice family photo as an everyday visible object. In the medium term, the permission to broadcast the photograph for public display was also supported. In the view of the inhabitants, it was necessary that their photographs circulate in order to testify to their conditions of existence as immigrants, and, thereby, to be able to express themselves publicly on this subject. Most of the people took part in the events organised around the exhibitions through vernissages, forums and debates, along with the charity organisations that accompany them on a daily basis. Thus, making their own photographs available at the exhibitions served as a medium for talking to observers, that is the photographer, the researchers and the wider audience, and connecting with them. Consequently, the act of presenting oneself physically, of going beyond the posture of the subject of photography and embodying immigration phenomena during various public events, brought a lot of meaning and spontaneity. Beyond the words of conversation, debates or exchanges were the moments of sharing food, songs, tales that emerged. For example, the first vernissage gave rise to some interesting scenes in terms of reversing social roles in different places: the hall of the university library was filled with groups of children and bathed in the smell of donuts and fried chicken as the immigrants offered meals to the exhibition visitors for almost two hours. We heard a cheerful Congolese woman say to one of the vice-presidents of the university: "Do you like my donuts? It's good! Eat, you're so skinny! And take, take all, you will give to your children." This possibility of going beyond social roles was also appreciated by the academic staff, who were delighted to be jostled in their functions by mostly anonymous figures. This possibility of going beyond social roles was also appreciated by the academic staff, who were delighted to be jostled in their functions by people who they otherwise might not have met. During and following the exhibitions, of which there had been four at the time of writing in early 2019, the confrontation and the exchange with the public's gaze allow us to go further in our work and our knowledge of the everyday experience of the inhabitants of the Jardins de la Poterie. The series of events around the exhibition in different public places gave us the opportunity to take the time to focus on details that might have eluded us. By taking part in public debates, we could note, for example, that people were all held to each other during the shooting, that the children did not come exclusively to be photographed with family members but with friends (photo 2). This enjoins us to study more precisely the body-sensitive relationships, interpersonal relationships, and / or collective feelings of belonging. For the inhabitants, the photographic approach was greeted positively, mainly because it did not impose a frame that obliged the residents to "give" something a priori and because it did not answer an institutional order put in advance. It is important, however, that this issue is treated ethically by photographers and researchers. Indeed, if the approach was initially disinterested financially and free from any institutional injunction, the "fundraising" which allowed the circulation of the exhibition had to respect the political and critical positions of the inhabitants, the photographer and the researchers. Our financial support has been found in public university institutions that claim to carry out research on the hospitality, reception and integration of all people within, in this instance France, and by charitable organisations supporting immigrants and homeless people. It is not conceivable, in the long-term, that this research is conducted, for example, through European Union institutional funds, a body considered as abusive by immigrants not only in the European territory but also in their countries or regions of origin. Research, creation and critical intent cannot be dissociated in this type of research in the geohumanities.

Conclusion

In this chapter, we have traced the passage from a "conventional" research in social geography to a research methodology enriched through the contributions of an artistic approach. By going beyond the argumentative role of research in the human sciences, by going beyond scientific postures seeking to "speak for", we have tried to bring something other than scientific proof or critical testimony about pregnancy and maternity in migration. We have also sought to trigger patterns of space and places hidden by academic traditions and introduce them into the artistic posture. This collaborative work opens new perspectives for research, but also for the art world, which could develop more "geographically aware" approaches (Creswell, Dixon, 2015). Indeed, the "spatial shift" does not only concern the social sciences but also the artistic world, insofar as we share common interests, particularly in the influence of places on the lives of individuals, their mobility, the relation of individuals and groups to their territories, the multi-scalar approach. Through the example of pregnancy, we show how the woman's body appears as the first envelope of the developing human being. This has enabled us to explore the relations between the accessibility of spaces and the female experience of pregnancy, understood as a unique experience occurring in a limited temporality, that of pregnancy. This temporality, nevertheless, makes it possible to re-examine the bodily experience (change in the centre of gravity) in physical and psychological terms (fulfilling pregnancy, cumbersome pregnancy) and its relationship with the spatial experience.

We have used here a sensitive approach to a bodily modification that alters one's relation to space as the modified body changes at the same time as the woman's direct relation to space, to places in terms of the places of well-being which are therefore regularly visited or the converse of anxiogenic places that are therefore avoided , to territories through the policies for the provision of prenatal healthcare assistance to women and particularly to immigrant women. This sensitive approach helps us to re-examine and analyse our data via the women's accounts while at the same time examining the investigative relationship and the researchers' own involvement.

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  Photo 1: Young girl

Photo 5 : Mother and her son