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Paper short abstract

I examine how statelessness shapes negative health outcomes among Assam’s Miya community. Settled by the British in climate-sensitive river islands, they now face targeted exclusion. My work analyses statelessness as a political determinant that drives health vulnerabilities.

Paper long abstract

This study examines the health consequences of statelessness among the Miya community in Assam, India. Originally settled by the British on climate-exposed river islands, the community now faces statelessness. Although scholarship has addressed the legal and political dimensions of statelessness, its public health implications remain underexplored. Drawing on Daniel Dawes’ framework of political determinants of health, this work analyses how statelessness functions as a political determinant of health.

Using a qualitative ethnographic approach rooted in an emic perspective, I conducted participant observation and in-depth interviews with stateless individuals, families affected by exclusion or detention, community health workers, and civil society actors. Fieldwork included time spent in detention centres, with families bereaved by suicide, and within hospitals and everyday community spaces, listening to narratives of fear, illness, and endurance. Interview transcripts and field notes were analysed using grounded theory.

Findings reveal a consistent pattern of adverse health outcomes produced through both political action and political inaction. Political action generated harm through mobility restrictions, forced displacement, torture, and violence. Political inaction contributed to negative outcomes through chronic underinvestment in climate-adaptive health infrastructure, failure to rebuild trust in health systems, and the absence of accountability for discriminatory or racially motivated medical negligence.

The study positions statelessness as a critical political determinant of health, demonstrating how state practices directly and indirectly shape the well-being of stateless populations. These insights offer a foundation for advocates, researchers, and health system actors seeking to advance the health rights and social justice claims of stateless communities.