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MIGRATION,
PALGRAVE STUDIES IN
SUB-NATIONAL
DIASPORAS ANDGOVERNANCE
CITIZENSHIP
Local Integration
of Migrants Policy
European Experiences
and Challenges
Edited by
Jochen Franzke
José M. Ruano de la Fuente
Palgrave Studies in Sub-National Governance
Series Editors
Linze Schaap
Tilburg University
Tilburg, The Netherlands
Jochen Franzke
University of Potsdam
Potsdam, Germany
Hanna Vakkala
University of Lapland
Rovaniemi, Finland
Filipe Teles
University of Aveiro
Aveiro, Portugal
This series explores the formal organisation of sub-national government
and democracy on the one hand, and the necessities and practices of
regions and cities on the other hand. In monographs, edited volumes and
Palgrave Pivots, the series will consider the future of territorial governance
and of territory-based democracy; the impact of hybrid forms of territo-
rial government and functional governance on the traditional institutions
of government and representative democracy and on public values; what
improvements are possible and effective in local and regional democracy;
and, what framework conditions can be developed to encourage minority
groups to participate in urban decision-making. Books in the series will
also examine ways of governance, from ‘network governance’ to ‘triple
helix governance’, from ‘quadruple’ governance to the potential of ‘mul-
tiple helix’ governance. The series will also focus on societal issues, for
instance global warming and sustainability, energy transition, economic
growth, labour market, urban and regional development, immigration
and integration, and transport, as well as on adaptation and learning
in sub-national government. The series favours comparative studies, and
especially volumes that compare international trends, themes, and devel-
opments, preferably with an interdisciplinary angle. Country-by-country
comparisons may also be included in this series, provided that they contain
solid comparative analyses.
More information about this series at

http://www.palgrave.com/gp/series/15960
Jochen Franzke · José M. Ruano de la Fuente
Editors
Local Integration
of Migrants Policy
European Experiences and Challenges
Editors
Jochen Franzke José M. Ruano de la Fuente
Economics & Social Sciences Department of Political and
University of Potsdam Administrative Sciences
Potsdam, Brandenburg, Germany Complutense University
Madrid, Spain
ISSN 2523-8248 ISSN 2523-8256 (electronic)

Palgrave Studies in Sub-National Governance
ISBN 978-3-030-50978-1 ISBN 978-3-030-50979-8 (eBook)
https://doi.org/10.1007/978-3-030-50979-8
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer
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Praise for Local Integration of
Migrants Policy
“A must-read for decision makers, scholars and stakeholders who are inter-
ested in how innovating migration policies go beyond the national level
and focus on the local dimension for effective integration. Evidence from
an array of European Union experiences explained in readable prose by
the best specialists will open your eyes to the possibilities hosted by the
local level for successful migrant-centred policies.”
—Aída Díaz-Tendero, Researcher, National Autonomous University of
Mexico
“This is the book that the whole of Europe—if not the whole World—
has been waiting for! It is well composed and thought provoking, and the
aspects of migration, integration policy and local governance are fluently
discussed. The representative selection of country cases illuminates inter-
esting viewpoints and history, and examines problems and solutions in
different contexts. Migration concerns municipalities—it concerns us all.”
—Hanna Vakkala, Faculty of Social Sciences, University of Lapland,
Finland
“A unique volume providing deep insights into practices of migration

integration and local governance in the context of migration processes in
European countries. Given the significance of migration issue for modern
societies (especially from the governance perspective) within current
global political economic and socio-cultural environment the provided
v
vi PRAISE FOR LOCAL INTEGRATION OF MIGRANTS POLICY
comparative analysis of European practices and experience of handling

the migration on local level turns out to be exceptionally relevant and
extremely important.”
—Andrey A. Kinyakin, Russian Presidential Academy of National
Economy and Public Administration (RANEPA), and Head of Science &
Education, Russian Public Opinion Research Center (VCIOM)
Contents
1 New Challenges in Local Migrant Integration Policy

in Europe 1
Jochen Franzke and José M. Ruano de la Fuente
2 Between Central Control and Local Autonomy:

The Changing Role of Swedish Municipalities
in the Implementation of Integration Policies 11
Christine Hudson, Katarina Giritli-Nygren, Gustav Lidén,
and Linda Sandberg
3 The Norwegian Case: Integration Through Local

Autonomy and Institutionalization 35
Susanne Søholt and Kristian Rose Tronstad
4 Finland’s Immigration Policy: State Objectives, Local

Solutions 53
Saara Koikkalainen
5 The Swiss Rationale of Integration Policies: Balancing

Federalism, Consociationalism and Direct Democracy 73
Stefanie Kurt and Gianni D’Amato
vii
viii CONTENTS
6 Migration in the Netherlands: Threats

and Opportunities 87
Laurens Jonathan Zwaan
7 Germany: From Denied Immigration to Integration

of Migrants 107
Jochen Franzke
8 Ireland’s Evolving Migrant Policy: Recurring

Rhetoric, Sporadic Action 123
Bríd Quinn
9 Reception of Asylum Seekers and Refugees in France:

Between Rigour and Humanism 141
Christophe Bonnotte and Michel Sénimon
10 Immigration and Integration Policies in Poland:

Institutional, Political and Social Perspectives 169
Małgorzata Mol˛eda-Zdziech, Marta Pachocka,
and Dominik Wach
11 Slovenian Migration Management at the Local Level 201

Uroš Pinterič
12 Local Integration Policy of Migrants in Croatia: In

Search of Coherence and Capacity 215
Ivan Koprić, Goranka Lalić Novak, and Teo Giljević
13 Romania’s Policy of Migration and Integration:

Unattractive Host Nation and Alternative Transit
Route 231
Iulia-Sabina Joja
14 Challenges of Immigrant Integration in Spanish Local

Governments 245
José M. Ruano de la Fuente
CONTENTS ix
15 Internal Geopolitics and Migration Policies in Italy 261

Giuseppe Bettoni and Isabella Tamponi
16 Public Opinion on Migration and the Role

of the Media in the Context of the “European Refugee
Crisis” 285
Saara Koikkalainen, Niko Pyrhönen, and Östen Wahlbeck
17 Integrating Immigrants: Capacities and Challenges

for Local Authorities in Europe 311
Jochen Franzke
18 Conclusions: An Overview of Local Migrant

Integration Policies in Europe 335
Index 345
Notes on Contributors
Giuseppe Bettoni Professor of Geography at the University of Rome

Tor Vergata since 2005. Expert in geopolitics, he studied Political Science
in Bologna (Italy) and Geography and Geopolitics at University of
Paris. He has lectured at several universities such as London School of
Economics, University College of London, Science Po Toulouse. His
research focus is the antagonism between territorial actors, territorial
organisations, decentralisation and identity issues particularly. In recent
years, he has studied the power balance following the effects of globalisa-
tion, and constitutional reforms with a specific interest on “metropolitan”
issues. A highly regarded lecturer and analyst, he is regularly solicited by
medias such as radios, televisions and press, especially in France and Italy.
Christophe Bonnotte is a Senior Lecturer in Public Law at the Univer-
sity of Limoges (France) and Secretary-General of the international NGO
EUROPA. His main research topics are: Administrative law, civil services,
political and territorial organisation of the State and public services.
Gianni D’Amato is Professor at the University of Neuchâtel, Director
of the Swiss National Centre of Competence in Research NCCR—on the
move and Head of the Swiss Forum of Migration and Population Studies
(SFM). His research interests focus on citizenship, mobilities, populism
and the history of migration.
xi
xii NOTES ON CONTRIBUTORS
Jochen Franzke Co-editor of the Palgrave Studies in Sub-National

Governance book series, board member of the Institute of Local Govern-
ment Studies at the University of Potsdam, co-chair of the European
Group for Public Administration (EGPA) Study Group on Local Gover-
nance and Democracy (2005–2018); research on local governance, local
democracy and public administration reform in Germany and Europe in
comparative perspective.
Teo Giljević PhD, is an Assistant professor of Administrative Science
at the Faculty of Law, University of Zagreb, Croatia. He is the author
of many articles in the field of public administration and governance of
migration and integration of migrants. His professional interest includes
public administration, human resources management, law enforcement
and human rights, governance of migration and integration of migrants.
He is a president of Commission for complaints in the Ministry of the
Interior of the Republic of Croatia, citizen’s committee for civil oversight
over police enforcement appointed by the Croatian Parliament.
Katarina Giritli-Nygren Professor of Sociology and Director of the
Forum for Gender Studies at Mid Sweden University. Her current
research addresses different forms of governance relationships with a focus
on spatial processes of inclusion and exclusion in terms of gender, class
and ethnicity in different contexts.
Christine Hudson Professor in political science at Umeå University. She
has researched extensively on various aspects of local and regional govern-
ment. In her recent work, she focuses on processes of inclusion and
exclusion particularly in relation to gender, age and ethnicity.
Iulia-Sabina Joja is a Transatlantic fellow researching Black Sea security
at the School of Advanced International Studies of the Johns Hopkins
University and an adjunct professor teaching European security at the
Georgetown University Security Studies Program. She was visiting scholar
with the Center for Military History and Social Sciences of the German
Armed Forces and an associate lecturer at the Bucharest University of
Economic Studies. Her main subjects of interest are European strategic
profiles, European governance and Euro-Atlantic security policies. She has
studied Political Science and International Relations at Freie Universität
Berlin and at the NSPAS Bucharest, holds a Master of Arts in Interna-
tional Conflict Studies from King’s College London War Studies Depart-
ment and wrote her Ph.D. on Romanian Strategic Culture (published
NOTES ON CONTRIBUTORS xiii
with Columbia University Press). Iulia has held positions at the United
Nations, the Romanian Ministry of Foreign Affairs, the European Parlia-
ment, NATO ACT and as adviser on security and defence at the Romanian
Presidency.
Saara Koikkalainen is a University Lecturer at the Karelian Institute of
the University of Eastern Finland. Her PhD thesis (2014) in sociology
focused on the labour market experiences of highly skilled intra-European
migrants. Her research interests include, for example, migrant labour
market integration, privileged and highly skilled migration and migra-
tion decision-making and she has published in, e.g., Nordic Journal of
Migration Research, Journal of Ethnic and Migration Studies, Journal
of Finnish Studies and International Migration. Her current research
examines the impact of the Brexit process on intra-European migration,
especially between the UK and the Nordic countries.
Ivan Koprić is president of the Institute of Public Administration and
Editor-in-chief, Croatian and Comparative Public Administration, New
books: Europeanisation of the Croatian Local Government (ed.; in Croa-
tian: Europeizacija hrvatske lokalne samouprave). Zagreb, Institut za
javnu upravu, 2018, Evaluating Reforms of Local Public and Social
Services in Europe: More Evidence for Better Results. Editors: Ivan Koprić,
Hellmut Wollmann, Gérard Marcou. Palgrave Macmillan, 2018, Migra-
tions, Diversity, Integration, and Public Governance in Europe and Beyond.
Stefanie Kurt is an Assistant professor at the school of Social Work at
the University of Applied Sciences and Arts Western Switzerland and IP-
Leader in the Swiss National Center of Competence in Research NCCR—
on the move. She holds a Master of Law degree in International and
European Law from the University of Bern and a Ph.D. in Law from the
University of Neuchâtel. In her research and publications, she discusses
questions of Migration Law and Policy, with a particular to Citizenship
and integration policies in Switzerland and Europe.
Goranka Lalić Novak PhD, is an Associate Professor of Administrative
Science at the Faculty of Law, University of Zagreb, Croatia. He is the
author of several books and many articles in the field of public admin-
istration and governance of migration, asylum and integration, including
the book Legal and Institutional aspect of Asylum, 2016 (in Croatian). For
the Government’s Office for Human Rights and the Rights of National
Minorities, he coordinated and prepared the Action plan for integration
xiv NOTES ON CONTRIBUTORS
of refugees at the local level (2018). He participated in several projects

aimed at the integration of migrants at the local level in Croatia.
Gustav Lidén Associate Professor of Political Science at the Department
of Humanities and Social Sciences at Mid Sweden University. His research
is focused at the local political arena and includes policy areas covering
migration and integration policy.
Małgorzata Mol˛eda-Zdziech Associate professor of Political Science
and Ph.D. in sociology. Since November 2017 she has been representing
abroad the Polish Academy of Sciences as the Director par Interim and
since June 2018 as the Director of Polish Contact Agency in Brus-
sels. She is also a member of Directory of the Association France-
Pologne and expert in the international non-government association
EUROPA(Entretiens Universitaires pour l’Administration Publique) in
Limoges (France). Since 2009 she has been a member of Citizens’ Legisla-
tive Forum, founded by Batory Foundation. She is an author and co-
author of numerous publications regarding lobbying, media and commu-
nications, including a book on celebrities in public life (Czas celebrytów.
Mediatyzacja życia publicznego/Time of celebrities. Mediatization of public
life, Difin, 2013). Her current research interests focus on: lobbying,
advocacy, groups of interest, media and communication.
Marta Pachocka is an assistant professor at the Department of Political
Studies of the Collegium of Socio-Economics of SGH Warsaw School
of Economics and at the Centre of Migration Research (CMR) of the
University of Warsaw. She is a coordinator of the EUMIGRO project—
“Jean Monnet Module on the European Union and the Contemporary
International Migration—an Interdisciplinary Approach” (2016–2019) at
SGH Warsaw School of Economics. She was one of two researchers in
the project entitled “Warsaw test project of integration of foreigners with
regard to the needs of the labor market” (WITEK), implemented by the
Office of Aid and Social Projects of the Capital City of Warsaw (2016–
2018). Her main research interests include: socio-demographic changes in
Europe/the EU and their consequences; international migration, migra-
tion and asylum in Europe; EU policy on migration and asylum; reception
and integration policies in Europe; forced migration studies; international
economics and international organizations.
Uroš Pinterič is a Professor of Political Science at the Alexander Dubček
University in Trenčin, Slovakia. Between 2017 and 2020, he was a Jean
NOTES ON CONTRIBUTORS xv
Monnet Chair. Prior to that, he was working in various higher education

institutions, including Charles University in Prague. He authored multiple
books, chapters and articles, covering a wide array of topics, from local
development to the modern development of political systems. His main
perspective was over time developed in the critical reflection of different
economic, political and social realities.
Niko Pyrhönen is a Postdoctoral Researcher at The Centre for Research
on Ethnic Relations and Nationalism (CEREN), University of Helsinki.
Since defending his PhD dissertation The True Colors of Finnish
Welfare Nationalism (Sociology, 2015), his research has focused on
right-wing populist hybrid media mobilization practices and narratives
in the ’alt-right’ news outlets in several countries as well as on transna-
tional conspiracy theories as political mobilization, and Christianism and
religion-based far-right affinities. His work has been published in, e.g.,
Sociological Inquiry and Discourse, Context & Media and his current
research focuses on cyclical peaking of hate speech in mainstream public
debate.
Bríd Quinn Prior to her recent retirement, Dr. Bríd Quinn worked in
the Department of Politics & Public Administration at the University
of Limerick. Her research and recent publications focus on local gover-
nance in Europe; EU territorial policies; administrative reform and higher
education policy. She is a member of the Council of Europe’s Group of
Independent Experts on Local Government and also carries out consul-
tancy work in Ireland and abroad for development organizations and state
bodies.
José M. Ruano de la Fuente is Ph.D. Professor of the Complutense
University of Madrid (UCM) and has been visiting scholar in several
European and American Universities. His main research fields are compar-
ative public administration and local governance. Currently he is Vice-
President and member of the Scientific Council of the European associa-
tion Entretiens Universitaires Réguliers pour l’Administration en Europe
(EUROPA) and member of the Permanent Study Group on Local Gover-
nance and Democracy in the European Group of Public Administration
(EGPA).
Linda Sandberg Senior lecture at the Centre for Gender studies at
Umeå University. In her research she focuses on spaces of gendered fear
xvi NOTES ON CONTRIBUTORS
of violence, and the intersections of race and gender as well as planning

for safety and security from a gender perspective.
Michel Sénimon is the General Delegate of the international NGO
EUROPA. After serving as Director of Human Resources (HRD) for the
Pyrénées Atlantiques Departmental Council in Pau, he was HRD for the
Limoges University Hospital Centre. He is currently Deputy Director-
General in charge of Human Resources at the University of Limoges. A
specialist in civil service law, which he has been teaching for many years
in different organisations, he has acquired, through his geographical and
functional mobility within the Territorial Civil Service, the Hospital Civil
Service and the State Civil Service, not only a solid professional experience
in the management of HR policies and reforms, but also a real profile as
a decision-maker and public manager.
Susanne Søholt main research areas: Migration to, and integration,
inclusion and diversity in rural and urban areas, Immigration and integra-
tion policies and politics, the role of the city in coping with a dynamic
multi-ethnic municipality, How different categories of immigrants and
minority population navigate to create wanted life situations, Housing
and integration.
Isabella Tamponi Assistant Professor of Geopolitics and Communica-
tions at the University of Rome Tor Vergata since 2012. She has
completed a Master’s in Communication and Information Sciences at
the University of Rome “Tor Vergata” (2011), and a Research Master’s
Degree in Geopolitics at the Yves Lacoste French Institute of Geopolitics
(IFG) at the University Paris 8 Vincennes-Saint-Denis. Professor Tamponi
specialises in communication, storytelling and cartography.
Kristian Rose Tronstad main research areas: Dynamics in migration,
immigration, mobility, Immigration policy and integration politics, Intro-
duction programmes for refugees, Gaps in welfare between the majority
and minority populations, Labour market integration.
Dominik Wach an affiliate in the Centre of Migration Research of the
University of Warsaw, researcher in the IMINTEG project – “In search
for models of relations between immigration and integration policies” co-
financed by the National Science Centre in Poland (2015–2018). Polit-
ical analyst who specializes in migration, integration and Middle Eastern
affairs, for over 10 years professionally involved in integration of refugees.
NOTES ON CONTRIBUTORS xvii
Coordinator on behalf of the Warsaw Family Support Centre of the

project entitled “Warsaw test project of integration of foreigners with
regard to the needs of the labor market (WITEK)”. Former human rights
observer in the West Bank (oPt) and humanitarian worker supporting
refugees in Jordan.
Östen Wahlbeck is a Professor of Sociology at the University of Helsinki,
Finland, and Adjunct Professor of Human Rights and Multiculturalism
at the University of South-Eastern Norway. He holds a PhD in Ethnic
Relations from the University of Warwick, UK. He has published widely
in the fields of Migration Studies, Economic Sociology, Multiculturalism,
and Refugee Studies, including several international books as well as arti-
cles in Ethnicities; Journal of Ethnic and Migration Studies; Journal of
Intercultural Studies; Journal of Refugee Studies; and Mobilities. He has
been the project leader of several large research projects funded by the
Academy of Finland.
Laurens Jonathan Zwaan is certified management consultant (CMC)
and researcher for the public sector in The Netherlands at Leeuwendaal.
Laurens is member of the scientific council of “Entretiens Universitaires
Réguliers pour l’Administration en Europe” (EUROPA) and is liaison
between EUROPA and Radboud University.
Abbreviations
ADA Asylum Seeker Allowance in France

AfD German Political Party (Alternative für Deutschland)
AME French State Medical Aid
AMIF European Commission’s Fund for Asylum, Migration and
Integration
ANAC Italian National Anti-Corruption Authority
ANCI National Association of Italian Municipalities
ATSA French Temporary Reception—Asylum Service
BVA French Polling and Social Research Institute
CADA Reception Centre for Asylum Seekers in France
CAES French Reception and Case Evaluation Centres
CAO Dutch Central Agency for the Reception of Asylum Seekers
CARA Italian Governmental Centres for Accommodation of Asylum
Seekers
CAS Emergency Reception Centres for Asylum Seekers in Italy
CBOS Centre for Public Opinion Research in Poland
CDA Accommodation Centres of Asylum Seekers in Italy
CDA Dutch Christian-Democrat Party
CESEDA French Code for Entry and Residence of Foreigners and
Right of Asylum
CII French Inter-Ministerial Committee for Integration
CIMADE French Inter-Movements Committee for Aid of Evacuees
CIP Swiss Cantonal Integration Programs
CNDA French National Asylum Court
CPSA Italian First Aid and Reception Centres for Asylum Seekers
CRC UN Convention on the Rights of the Child
xix
xx ABBREVIATIONS
CRHH French Regional Housing and Accommodation Committees

CSO Irish Central Statistics Office
CU Dutch Christian Party
DA French Directorate of Asylum
DAAEN French Reception, Support for Foreigners and Nationality
Directorate
DASS Irish Directorate for Asylum Support Services
DGM Dutch Directory General for Migration
DIAIR French Inter-Ministerial Delegation for Reception and Inte-
gration of Refugees
DIHAL French Inter-Ministerial Delegation for Housing and Access
to Housing
DNA French National Reception Facility System for Asylum
Seekers and Refugees
DTV Dutch Service for Return and Departure
DUO Dutch Education Executive Agency
EASO European Asylum Support Office
ECHR European Court of Human Rights
EEA European Economic Area
ESF European Social Fund
ESRI Irish Economic and Social Research Institute
ESS European Social Survey
EU European Union
EUMIGRO Jean Monnet Module on European Union and Contempo-
rary International Migration
EUROSTAT European Union Statistical Office
FAQ Frequently Asked Questions
FNA Swiss National Foreigners Act
FNIA Swiss Foreign Nationals and Integration Act
FNPSA Italian National Fund for Asylum Policies and Services
GDP Gross Domestic Product
GUDA French Asylum Applications One-Stop Shops
GUS Polish Main Statistical Office
HSE Irish Health Service Executive
HUDA French Asylum Seeker Emergency Shelter
IAAP Irish Integrated Academy for Athletic Performance
ICAR Foundation in Romania
ICI Integration Climate Index
ID-card Identity Card
IFOP French Institute of Public Opinion
IIP Individual Integration Programmes in Poland
IMF International Monetary Fund
ABBREVIATIONS xxi
IMISCOE International Migration, Integration and Social Cohesion

Research Network
IMR International Migration Review
IND Dutch Immigration and Naturalisation Service
INIS Irish Naturalization and Immigration Service
INTREO Irish Department of Social and Family Affairs
IOM International Organization of Migration Within UN
ISAF International Security Assistance Force Program
IWG Integration Working Group
JHA Romanian Justice and Home Affairs Council
JLD French Administrative Court to the Judge of Freedoms and
Detention
JRS Jesuit Refugee Service
KDS Committee for Social Dialogue for Foreigners
KELA Finnish National Social Insurance Institution
KGSt German Municipal Association for Administration Manage-
ment
LEADER French acronym for “Liaison Entre Actions de Développe-
ment de l’Économie Rurale”
LECP Irish Local Community and Economic Plan
LSDC Irish Local Community Development Committee
MIGRI Finnish Immigration Service
MIPEX Migrant Integration Policy Index
MMC RTV SLO Slovenian Radio-TV
MSNA Unaccompanied Foreign Minor (Italy)
NCCR Swiss National Centre of Competence in Research
NCP Irish New Communities Partnership
NGO Non-Governmental Organization
OECD Organization for Economic Co-operation and Development
OFII French Office of Immigration and Integration
OFPRA French Office for the Protection of Refugees and Stateless
People
OPMI Irish Office for the Promotion of Migrant Integration
PiS Political Party in Poland (Law and Justice)
PO Political Party in Poland (Civic Platform)
PPN Public Participation Network
PRAHDA French Reception and Accommodation Programme for
Asylum Seekers
RIC Republican Integration Contract in France
RS Republic of Slovenia
SALAR Swedish Association of Local Authorities and Regions
SDP Social Democratic Party in Romania
SDS Slovenian Democratic party
xxii ABBREVIATIONS
SER Dutch Social and Economic Council

SFI Swedish for Immigrants Training programme
SFS Swedish National Union of Students
SIPROIMI Italian System for Holders of International Protection and
Unaccompanied Minors
SIU Iris Local Authority Social Inclusion Unit
SIV Swedish Migration Agency
SKL Association of Swedish Municipalities as Well as Provincial
Parliaments
SNS Slovenian National Party
SOP Standard Operating Procedures
SOU Swedish Commission on the Reception of Refugees
SPRAR Italian Project for Protection System for Refugees and
Asylum Seekers
SURS Statistical Office of the Republic of Slovenia
SVR German Council of Experts for Integration and Migration
TFEU Treaty on the Functioning of the EU
TNC Third-Country National
UK United Kingdom
UNAR Italian National Anti-Discrimination Office
UNHCR United Nations High Commissioner for Refugees
UNICEF United Nations Children’s Fund
URSZR Slovenian Office Protection and Rescue
VLS-TS Visas Valid for Residence Permit in France
VVD Dutch Liberal Party
WW World War
List of Figures
Fig. 3.1 Increase in immigrant population (immigrants

and Norwegian-born to immigrant parents) by origin,
world continents 1970–2018. Source Statistics Norway,
Population statistics 37
Fig. 14.1 Evolution of immigrant population in Spain (2008–2019)
(Source Own elaboration on the basis of data
from the National Institute of Statistics) 246
Fig. 14.2 Evolution of asylum seekers in Spain (2008–2019)
(Source Ministry of the Interior) 249
Fig. 16.1 The support (percent) for a common European policy
on migration 297
Fig. 16.2 The frequency (percent) of immigration mentioned
as one of the two most important national concerns 298
Fig. 16.3 The frequency (percent) of immigration mentioned
as one of the two most important EU issues 300
xxiii
List of Tables
Table 3.1 Immigrants and Norwegian-born to immigrant parents,

by country background 38
Table 4.1 Humanitarian migration in Finland 2013–2017 66
Table 6.1 Population and migration in the Netherlands
1900–2018 (×1000) 89
Table 6.2 Average yearly population and migration 1901–2018
per year per decennium (×1000) 91
Table 6.3 Population and migration in the Netherlands
2005–2018 (×1000) 94
Table 6.4 Public opinion in the Netherlands on migration 98
Table 8.1 Immigration statistics Ireland 1987–2017 124
Table 8.2 Place of birth of Irish citizens 2016 125
Table 10.1 Attitudes towards receiving refugees from countries
affected by armed conflicts (in %) 187
Table 10.2 Attitudes towards receiving refugees from countries
affected by armed conflicts vs. party electorates (in %) 188
Table 10.3 Attitudes towards the relocation of refugees
from the Middle East and Africa 189
Table 10.4 Decision to accept refugees from Muslim countries
in the context of the threat of losing financing from EU
funds 189
Table 12.1 Migration balance 2008–2017 217
Table 17.1 Basic case indicators for migrant integration policy 322
Table 17.2 Indicators of local migrant integration policy
in Brandenburg cases 330
xxv
CHAPTER 1
New Challenges in Local Migrant

Integration Policy in Europe
This book mainly examines new challenges and approaches in national

and local migrant integration policy (hereafter referred to as ‘integration
policy’) in European countries. The so-called European refugee crisis,
which up to now culminated in 2015, dramatically heightened the need
for effective and coordinated integration policies. This applied to all
political and administrative levels, from the EU Commission at the supra-
national European level, the national governments of its member states to
the regional and, not least, local authorities. This has inevitably resulted
in a further diversification of policies regarding refugees, asylum seekers
and other categories of migrants in Europe.
J. Franzke (B)
Economics and Social Sciences, University of Potsdam, Potsdam, Germany
e-mail: franzke@uni-potsdam.de
J. M. Ruano de la Fuente
Department of Political and Administrative Sciences, Complutense University,
Madrid, Spain
e-mail: jmruano@cps.ucm.es
© The Author(s) 2021 1

J. Franzke and J. M. Ruano de la Fuente (eds.), Local Integration
of Migrants Policy, Palgrave Studies in Sub-National Governance,
https://doi.org/10.1007/978-3-030-50979-8_1
2 J. FRANZKE AND J. M. RUANO DE LA FUENTE
After a long development process, the European Union finally granted

their citizens the right to freedom of movement and residence within their
territory in 2004. Since then, the term ‘immigrant’ within the European
Union has officially exclusively used to refer to non-EU citizens. Accord-
ingly, the European commission defines ‘immigration’ as the action by
which a person from a non-EU country establishes his or her usual resi-
dence in the territory of an EU country for a period that is, or is expected
to be, at least twelve months. Nevertheless, large parts of the population
still regard all kinds of immigrants as foreigners.
Immigration today is one of the main political challenges of European
integration and perhaps even the future of the EU hinges on solving this
issue. The number of people with citizenship of a non-member country
residing in an EU Member States on 1 January 2018 was 22.3 million,
representing 4.4% of the EU-28 population. In addition, there were 17.6
million persons living in one of the EU Member States other than that of
their citizenship (Eurostat 2018).
1.1 Multi-Level Governance

and Migration Policy
In the context of migration, the scientific literature focusses more
frequently on the terms cultural, structural and social integration of
migrants (see Heckmann 2015, p. 72; Freeman and Mirilovic 2016; Bret-
tell and Hollifield 2000) by set apart between the social integration of
individuals and that of system integration, which deals with group-related
and institutional processes. The latter is the focus of our book.
The integration of migrants is both a final goal and a long-term
process. Alba and Nee (2003, p. 23) formulate it like this: “Integration is
a process wherein immigrant newcomers and the communities in which
they settle – both the individuals and institutions – mutually adapt to
one another. Integration is also an endpoint reached when individuals
only minimally perceive themselves and others in ethno-racial and national
terms, when these attributes have, at most, a negligible negative impact
on opportunities and life chances”.
Competences in the policy field of migration and integration are
distributed across different layers within the multi-level governance
system in the European Union, its member (national) states, the regions
and the local tiers of government (counties and municipalities).
1 NEW CHALLENGES IN LOCAL MIGRANT … 3
The focus of this volume is on the developments in integration policy

at the local level. Nevertheless, there is a strong link between national and
local integration policies. Additionally, the national integration policies
in Europe differ vastly between the EU countries, as well as over time.
Therefore, not only the national legal framework of integration policy,
but also the current political and cultural debate on the integration of
migrants at the national level should be included. At the same time, we
must remember that the traditional state-centric modes of government
increasingly fall short of ‘addressing the complex nature of contemporary
integration challenges’. As a result, more polycentric approaches of gover-
nance have gradually emerged between a range of government actors, as
well as semi-public, non-governmental and even private organisations. In
fact, since the so-called refugee crisis in 2015, local governance networks
in many EU countries have demonstrated that they can react more quickly
and more effectively to the new challenges than any state institution. At
the same time, of course, they also present a challenge to the formula-
tion of a coherent and consistent integration policy at the national level
(Scholten 2012, p. 47).
Scholars and policy makers have long focused predominantly on the
national level when analysing migration and integration policy. Yet,
scholars have increasingly recognised that “while we often think of immi-
grants as moving from one country to another, really they arrive from
a particular place and settle in a particular community” (Singer 2012,
p. 9). Migration concerns municipalities, and consequentially, its bene-
fits and burdens are most experienced at the local level (Scholten and
Penninx 2016, p. 89). When migrants arrive in their communities and
plan to live there, local authorities have a responsibility to act. When no
national integration policy exists or is counterproductive, local authorities
forced to develop their own integration policies shaped by pragmatism,
participation and trust (Scholten and Penninx 2016, p. 99). Municipali-
ties, especially larger cities, tend to take on a more active role, not only
in policy implementation, but also in policy formulation and in policy
exchange (Capono and Borkert 2010, p. 11). In light of this, the question
arises whether these new polices still follow the models of their national
state or whether distinct local approaches already exist.
In this context, we present three hypotheses. First is the national
model thesis, which assumes a top-down hierarchical government structure
and consequently claims that local authorities predominantly implement
national migration policies (Dekker et al. 2015). Second is the local
dimension thesis, which argues that all policies adopted by municipali-

ties share certain common characteristics. While some are more pragmatic
and place greater emphasis on cooperation with migrant organisations to
better fulfil their needs, others are more exclusive and restrictive to migra-
tion, fearing that migrant communities could threaten social peace and
public order in the receiving societies (Capono and Borkert 2010; Dekker
et al. 2015). Third, the individualisation thesis claims that each local
authority develops its own, distinct policy. This is determined by specific
indicators such as the economic situation, existing migrant population and
local political culture as well as other factors including the housing situ-
ation, level of employment, demographic issues, public safety and access
to services (Dekker et al. 2015; Gambetta and Gedrimaite 2010; Juzwiak
et al. 2014).
1.2 The Role of Local

Authorities in Integration Policy
Above all, since 2015 the role that local authorities play in the integration
of migrants has increased sharply in many European countries. This role
“has developed from primarily a level of policy implementation to a level
of policy development” (Scholten and van Breugel 2018, p. 3). Many
municipalities in a number of European countries have moved towards
an active integration policy, sometimes beyond the scope of their formal
competences in this area (OECD 2018).
The so-called European refugee crisis of 2015 has accelerated this
development and the focus of policy makers and scholars has thus shifted
towards the local level.
New challenges have also emerged at the horizontal level (see Kraal and
Vertovec 2017). Local integration policy now focuses much more on in-
house cross level and cross-department coordination within local admin-
istration than in the past. The ability to respond to multi-dimensional
needs and create opportunities for migrants’ calls for strong coherence in
implementation measures related to housing, health, employment, educa-
tion, welfare, etc. (OECD 2018). Additionally, cooperation between local
authorities and local (non-state) stakeholders or actors is increasing, for
example civil society institutions supporting migrants and refugees, or
local private firms offering employment opportunities, etc. Also, in the
vertical dimension, new challenges of coordination between the different
levels of governments have emerged, including an increasing number
of conflicts over the resources and competencies in this area. All these
changes present a huge challenge to local administrative capacity and local
finance.
1.3 Dimensions of Local

Integration Policy of Migrants
Dekker et al. (2015) found that there is either a “specifically local
dimension to integration policies” (p. 634), or that local governments
follow their national counterparts in terms of policy goals, processes and
underlying ideologies. The significance of local policies for successful inte-
gration, along with the possible tools and challenges for municipalities
and policy learning between local governments, are increasingly being
analysed in the literature (e.g. Juzwiak et al. 2014; Scholten and Penninx
2016). However, up to now only few studies evaluate the question of a
distinct local dimension, with the exception of Dekker et al. (2015).
Integration is a very complex, multi-dimensional concept and policy
field to analyse from various perspectives (Entzinger and Biezeveld 2003;
Juzwiak et al. 2014; Vetrovec 2010). The latter define integration as “all
activities that seek to incorporate migrants and/or refugees into a city”
(p. viii). Thus, integration policy includes all policy fields that “contribute
to making immigrants and refugees a functioning part of society and that
guarantee rights to these populations” (p. viii).
Integration policy generally refers to political-administrative action that
has to do with the integration of migrants into the host society. The two
basic theoretical approaches can be termed as ‘integration’ or ‘assimila-
tion’, each with multiple gradations and mixtures. In any case, adaptation
activities on the part of either the migrants and/or the host society are
expected. Any interaction or understanding of adaptation, such as incor-
poration and inclusion, requires the process of mutual adaptation between
migrants and the existing local society.
Dekker et al. (2015) distinguish between four different models of
(national) integration policy: the assimilationist, multicultural, universalist
and differentialist model. Assimilationist policies encourage migrants to
adapt their behaviour, cultural norms and values; a “unidirectional inte-
gration of the immigrant into the host society” (p. 639) is demanded.
By contrast, multicultural policies recognise the positive potential of
migrants and encourage their emancipation. These policies are sensitive
to the needs and problems of migrants and institutionalise their specific
identities. In this model, a multicultural society viewed as desirable and

associated with the concept of diversity is more likely to see equality
rights, potential and opportunities associated with migration. Policies
focusing on the legal-political or socio-economic domain can be clas-
sified as universalist or differentialist. The former contains policies that
do not explicitly recognise differences between groups, but targets the
individual, his rights and obligations. The respective tools and measures
described best as “mainstreaming” (Scholten and van Breugel 2018). If
policies aim to preserve group identities, institutionalise group boundaries
or lead to the segregation of different groups, they belong to the sphere
of differentialist policies (Dekker et al. 2015, p. 639).
The division of integration policies into several sub-dimensions seems
suitable for structuring the analysis and making comparisons more trans-
parent. The three dimensions commonly used in the literature are the
socio-economic, socio-cultural and legal-political one (e.g. Alexander
2007; Entzinger and Biezeveld 2003; Boswell 2003). The socio-
economic dimension mainly contains policies on the labour market,
education, social services and social welfare. Cultural and religious poli-
cies, as part of the socio-cultural dimension, contain, for example provi-
sions for recognising and dealing with different religious groups, societal
core values and language challenges. Finally, the legal-political dimension
contains all questions relating to equal rights, participation in decision-
making (especially voting rights), self-organisation of migrants and their
citizenships.
1.4 About This Book

Limited knowledge appeared to be available, especially on the impact
and results of integration policies in cities and municipalities. In addi-
tion, there have only been a few European comparative scientific studies
analysing this specific theme. Furthermore, the role of local authorities
in this policy field and their cooperation with civil society initiatives, or
networks in particular, are underrepresented topics in these studies. This
has led to serious gaps in both the body of academic knowledge and
in policy-focused knowledge. This volume will contribute to filling both
these gaps.
Altogether, the case studies in this book will present a good overview of
a variety of migration policies and the various institutional arrangements
within and amongst different actors, such as local administrations, local

councils, local media, local economy and local civil society initiatives.
As previously mentioned, the main aim of this book is to explore the
dynamics, experiences and drivers of integration policy at the local level
in different European countries. Above all, the authors focus on develop-
ments in this policy field following the summer of 2015, when the influx
of refugees from outside Europe reached its peak. Since then, migration
related issues have become one of the major societal problems facing most
European countries. At the same time, these issues are causing dramatic
polarisation and domestic conflicts in a number of European countries,
including the rise of anti-migration political parties. The degree of diver-
sity between the EU countries has clearly increased since 2015, sometimes
even within these countries.
Migration as a topic is extremely complex as within the European
and nation-state multi-level system competences spread across different
political and administrative levels. The focus of this book is on the local
authorities’ policy, which in any case needs to address this issue because of
the presence of migrants in their community. For each individual country
case, the authors attempt to answer whether the local authorities are able
and willing to play a pioneering role in the integration of migrants and
what limits are set by the national framework conditions.
Part II of the book consists of 14 country-specific chapters, which
allow a European comparison and show the increasing variance in migra-
tion policy approaches within and between European countries. The
degree of local autonomy, the level of centralisation and the traditional
forms of migration policy are factors that especially influence the possibili-
ties for local authorities to formulate their own integration policies. In our
sample, the case studies on Germany, the Netherlands and Switzerland
represent Central Europe; Sweden, Norway and Finland the Scandina-
vian area; Ireland the Anglo-Saxon area; and France, Spain and Italy
the Continental European Napoleonic Space. Of particular importance
in our sample is the inclusion of post-communist countries in Eastern
and Southern Europe, which had a completely different migration history
from that of the west of the continent in the twentieth century. The case
study on Poland represents Central and Eastern Europe, while Romania,
Croatia and Slovenia represent South-East Europe.
All country chapters in this book structured as far as possible according
to the same pattern. At the beginning of each chapter, we deal with
the basic aspects and specific features of national migration policy, which
includes the traditional forms of migration and integration policy as well

as the specific values underlying national policies. We then provide an
analysis of the constitutional regulations of migration and the distribu-
tion of responsibilities for integration policy across the different tiers of
the political-administrative system. Wherever possible, the focus is on
local authorities in cities and municipalities. Based on the current chal-
lenges of local integration policies, the authors examine the effectiveness
of policy instruments applied, policy implementation and the results of
implementation, respectively.
Part III of the book consists of two specific thematic chapters deep-
ening the analysis in two specific cases. Jochen Franzke analyses the
challenges facing local authorities in Europe of integrating migrants,
their administrative capacities and the problems of coordination between
different branches of local administration in this policy field. Östen
Wahlbeck, Saara Koikkalainen and Niko Pyrhönen examine the develop-
ment of public opinion within the European Union on migration since
2015, and the role played by the media in the context of the ‘European
refugee crises’.
Finally, in the conclusions (Part IV), the editors, Jochen Franzke and
José Ruano, summarise the most important results in the foregoing
chapters and provide an outlook for further research.
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Alexander, M. (2007). Cities and Labour Immigration Comparing Policy
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Brettell, C. B., & Hollifield, J. F. (2000). Migration Theory: Talking Across
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Integration: 20 Cities, 20 Good Practices. Washington, DC: National League
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CHAPTER 2
Between Central Control and Local

Autonomy: The Changing Role of Swedish
Municipalities in the Implementation
of Integration Policies
Christine Hudson, Katarina Giritli-Nygren, Gustav Lidén,

and Linda Sandberg
C. Hudson (B)
Department of Political Science, Umeå University, Umeå, Sweden
e-mail: christine.hudson@umu.se
K. Giritli-Nygren · G. Lidén
Department of Humanities and Social Sciences, Mid Sweden University, Mid
Sweden, Sweden
e-mail: katarina.giritli-nygren@miun.se
G. Lidén
e-mail: gustav.liden@miun.se
L. Sandberg
Umeå Centre for Gender Studies, Umeå University, Umeå, Sweden
e-mail: linda.sandberg@umu.se
© The Author(s) 2021 11

J. Franzke and J. M. Ruano de la Fuente (eds.), Local Integration
of Migrants Policy, Palgrave Studies in Sub-National Governance,
https://doi.org/10.1007/978-3-030-50979-8_2
12 C. HUDSON ET AL.
2.1 Introduction
The underlying goal of Swedish integration policy is ‘to ensure equal
rights, obligations and opportunities for all, irrespective of their ethnic
and cultural background’.1
As a Scandinavian country, Sweden is often characterized as a decen-
tralized unitary state in which the local level has both broad autonomy
and a multitude of responsibilities within the welfare sector (Lidström
2011). In terms of migration policy, Sweden represents, together with
the Netherlands, the longest tradition of maintaining a specific local policy
within this area (Penninx 2015). The role played by the local level has,
however, varied over the years, not only because of domestic changes, for
example, in the political complexion of national governments, but also
because of altering circumstances internationally. Nevertheless, the munic-
ipality remains important with regard to migration and integration. The
aim of this chapter is to provide a broad picture of Swedish local govern-
ment’s responsibilities, the changing nature of the role it has played and
is playing with regard to refugee reception and integration policies and
the challenges it currently faces.
2.2 Background: Swedish Migration

Policy in a Historical Perspective
Even though Sweden is considered to be a country with a long history
of having a generous migration policy, it is also a history of restric-
tion. Looking more closely at this policy area, it is possible to identify
a number of quite different phases in which immigration and integration
policies have oscillated between liberal and more restrictive characteris-
tics. After the Second World War, foreign labour was welcomed to fill
vacancies in Sweden’s expanding industries. However, in 1967, Swedish
trade unions pushed for a more restrictive policy which, in conjunction
with the economic recession in the early 1970s, resulted in Sweden only
receiving labour migration from the other Nordic countries (Lundh and
Ohlsson 1999). However, this tighter regulation was followed in 1975 by
a completely new immigration policy that was formulated as a response
to a situation in which Sweden had increasingly become a destination
1 https://www.government.se/government-policy/introduction-of-new-arrivals/goals-
and-visions-of-introduction-of-new-arrivals/.
2 BETWEEN CENTRAL CONTROL … 13
country for refugees. This policy, with the motto of equality, liberty
and collaboration, had multicultural characteristics. It aimed to ensure
that new minority groups would be given support to preserve their own
culture as well as being provided with the Swedish welfare state’s full
range of services (Borevi 2012; Lundh and Ohlsson 1999).
In 1985, integration policies were institutionalized at the local level,
but were to be achieved in cooperation with AMS the national govern-
ment labour market agency (the predecessor to the current Swedish
Public Employment Service) and SIV the Swedish Immigration Agency
(the predecessor to the current Swedish Migration Board) (Lundh and
Ohlsson 1999; Bäck and Soininen 1998). However, almost simultane-
ously the Government enforced a new policy, later summarized as the
‘Whole of Sweden Strategy’, which circumvented local autonomy and
permitted national government to place immigrants in all the munici-
palities (Borevi 2012). Both these policies were later reformed by the
centre-right government that took office in 1991 and which was in charge
when significant numbers of refugees fled to Sweden from the former
Yugoslavia. The new Government refocused integration policy and placed
emphasis on establishing immigrants in the labour market as well as trying
to solve housing problems by making it possible for asylum seekers to find
their own accommodation. The latter measure obviously altered the possi-
bilities for national government steering of the placement of immigrants
(Borevi 2012). The ‘Whole of Sweden Strategy’ was thereafter terminated
and a system was established in which national government negotiated
with the municipalities on the reception of immigrants. However, this
did not affect the possibility for immigrants to resolve their own housing
situation.
After joining the EU in 1995, Sweden’s policy underwent a refocus
when it incorporated EU policy and shifted from immigration to integra-
tion policy, which stressed not only the rights of immigrants but also
their obligations (Lidén et al. 2015). In 1997, the social democratic
government introduced a new integration policy (Prop. 1997/98:16)
that was to guarantee newly arrived immigrants a two-year long intro-
ductory phase, administered by local government, to help them assimilate
into Swedish society. After this period, no specific measures beyond the
traditional welfare state services were to be provided. This reform down-
played multiculturalism and features of a stricter policy became apparent
(Borevi 2012). Thus, for example, more restrictive provisions with regard
to the immigration of family members were introduced. The age limit for
14 C. HUDSON ET AL.
family reunification was lowered to apply to children under the age of 18

(previously 20) and the possibility for elderly parents to reunite with their
children in Sweden was removed.
In July 2006, the growing numbers of unaccompanied minors seeking
asylum led to changes in Swedish legislation. Responsibility for providing
accommodation for this group was transferred from the Swedish Migra-
tion Board to the municipalities. The reception of unaccompanied minors
subsequently followed a pattern that was influenced by local political
opinion and structural preconditions in municipalities (Lidén and Nyhlén
2016). Later the same year, a centre-right government took office and,
during their following two terms of office, two noteworthy policy changes
were implemented. Firstly, the ‘establishment reform’ was launched in
2010 under the Establishment Measures for Newly Arrived Immigrants
Act (Lag 2010:197) which had important consequences for the role
of the local level. Under this reform, responsibility for integration was
centralized and placed under the aegis of the national government agency,
the Swedish Public Employment Service. The reason stated for this was
that the integration of immigrants in the labour market had been largely
unsuccessful and that there was considerable variation in how municipal-
ities handled this issue (Lidén et al. 2015). Up to this point, integration
policy had been highly decentralized and implemented largely at the
municipal level with the municipalities ‘fully in charge of providing and
administrating the introduction programme’ (Wiesbrock 2011, p. 55).
However, the municipalities retained an important role in the reception
of newly arrived refugees, particularly with regard to housing, schooling
and education. (This is discussed further in the section on the distribu-
tion of responsibilities). The 2010 reform also emphasized ‘activation’
and gave increased attention to the individual migrant’s obligations to
establish him/herself in the labour market (Qvist 2016). Secondly, the
Government reached an agreement with the Green Party in 2011 that
involved a general liberalization of migration policies, both in terms of
the regulation of entry to Sweden and how integration policies were to
be outlined and targeted (Bolin et al. 2014).
2.3 Contemporary National Migration

Policy: From Generous to EU Minimum
In the wake of Sweden becoming an increasingly important desti-
nation country for immigrants with the numbers of people seeking
asylum in Sweden increasing substantially over several successive years
(Riksrevisionen 2017), there have been enormous changes in migration

policy. Sweden has gone from having the EU’s most generous asylum
laws to the minimum EU level. In autumn 2015, Sweden faced immi-
gration on an unprecedented scale as people fled from war zones and
violence. As the refugee situation escalated, many services were under
strain by the early autumn of 2015. More than 163,000 applications
for asylum were received during 2015, over half of them in the period
September–November (Migrationsverket 2016). Over 35,000 of these
were unaccompanied minors. Relative to its population size, this was the
highest yearly inflow of asylum seekers ever experienced in an OECD
country (OECD 2016). The Government, responsible government agen-
cies (particularly the Swedish Migration Agency), the County Adminis-
trative Boards and municipalities were under a heavy workload and were
forced to reprioritise extensively to manage the situation (Riksrevisionen
2017). The initial engagement and support for refugees was followed by
political debate and public opinion demanding that limitations should be
put on the numbers granted asylum and shelter. The Government sought
to ensure a more manageable situation and agreement on a more restric-
tive policy was reached in a broad coalition of parties comprising the
Government (the Social Democratic Party and the Green Party) and the
opposition Alliance (the Moderate, the Centre, the Liberal and Christian
Democratic Parties). In November 2015, the Government also intro-
duced temporary border controls at Sweden’s intra-Schengen borders,
for example, with Denmark. These ‘temporary’ border controls were
prolonged several times during 2016 and 2017 and have currently been
extended to 11 November 2020. Persons entering Sweden at these border
crossings are required to show proof of their right to enter and stay in the
country, for example, by providing a passport or national ID-card.
The key role played by Swedish municipalities in the reception and
integration of refugees (Lidén and Nyhlén 2015) led to mounting
concern about how they would cope with the increasing arrival of refugees
many of whom were in poor health and suffering from trauma. Refugee
reception and the placement of centres became a burning issue (Ander-
sson 2016). Previously, it had been voluntary for municipalities to accept
refugees which meant that some municipalities took considerable respon-
sibility while others did nothing. Furthermore, somewhat surprisingly, the
actual placement of newly arrived refugees have been more frequent in
municipalities with weak preconditions for successful labour market inte-
gration than in those with strong preconditions (Wennström and Öner
16 C. HUDSON ET AL.
2015). It was argued that, in order to ensure better organization of

refugee reception, speed up the integration of newly arrived refugees in
society and their establishment in the labour market as well as reduce
rising costs, all municipalities should be required to accept refugees.
Thus, in March 2016, legislation (Lag 2016:38) was introduced that
gave municipalities and national government agencies joint responsibility
for receiving refugees. Under this legislation it was made mandatory for
all municipalities to accept refugees and to provide (either themselves or
in coordination with other actors) accommodation and services such as
health care, language training, schooling for children, leisure activities and
work training/experience. This was often on an unprecedented scale for
many small municipalities and they experienced difficulties in complying
with the regulations. The Swedish Migration Agency was heavily criti-
cized by the Swedish National Audit Office (Riksrevisionen) for focusing
on its own activities during this crisis and thus placing ‘municipalities
into situations that forced them to contravene central government regula-
tions on schools, social services and reception of unaccompanied minors’
(Riksrevisionen 2017, p. 12).
In June 2016, the Reception of Asylum Seekers Act (Lag 1994:137)
was altered so that an asylum seeker whose application for asylum is
refused automatically loses the right to aid if s/he does not leave the
country voluntarily. Once a definitive decision has been made that the
asylum seeker is to be expelled or deported, the right to a daily allowance
and to asylum accommodation paid for by the Swedish Migration Agency
is withdrawn. An exception is made for families with children under 18
and these still have the right to aid until they leave the country.
In addition to actions taken by the Government to reduce the influx
of immigrants to the country, a number of policy changes concerning
integration were initiated. In July 2016, a new approach to residence
rights was introduced under the Temporary Limitation on the Possi-
bility to Obtain Residence Permit in Sweden Act (Lag 2016:752). This
Act made temporary rather than permanent residence permits the norm.
Under previous legislation, all persons in need of protection generally
received a permanent residence permit. According to the new legislation,
those applying for and given asylum now usually only receive a temporary
residence permit. Those who are granted refugee status receive a three-
year residence permit, and those who obtain the status of persons eligible
for subsidiary protection receive a 13-month residence permit. When the
permit runs out, the possibility of repatriation of the person to his or her
country of origin is re-evaluated. For those granted refugee status, if they

are able to support themselves by the time their residence permit expires,
they may be granted a permanent residence permit. For those granted
subsidiary protection status, their permit may be extended if there are
still reasons for them to require protection when the initial permit expires.
This temporary law also limits asylum seekers’ ability to reunite with their
families. Only those who receive refugee status and a three-year residence
permit will be given an opportunity for family reunification. The stricter
requirements for family reunification include that reunification will only
be permitted if the applicant can provide for those arriving (previously
the requirement was only that the applicant could support him/herself).
The asylum seeker must also have a home of a size and standard that is
sufficient for the family to be able to live there together.
This law was presented as a temporary solution to handle a challenging
situation and was to be valid until July 2019. However, support has been
lacking in the Swedish parliament for a return to a more liberal migration
policy. A bill (Prop. 2018/19:128) has been introduced that prolongs
the more restrictive migration policy for a further two years until July
2021. This continuation of the more restrictive policy has been reached
in an agreement between the governing coalition, the Social Democratic
Party and the Green Party, and the Liberal and Centre Parties. Never-
theless, a number of changes have been introduced that lessen some of
the restrictions. For example, previously only a person with refugee status
could be reunited with his or her family in Sweden, this right has now
been extended to those with a status as a person in need of subsidiary
protection. A further change is that someone classed as a stateless person
may now, under certain circumstances, be eligible to receive a permanent
residence permit.
2.4 Distribution of Responsibilities

Over the Different Tiers
of the Political-Administrative System
Traditionally refugee reception has been a policy area ‘with a strong
tradition of collaborative governance, decentralized decision-making and
a relationship between central and local government characterized by
negotiation, dialogue and reciprocity’ (Qvist 2016, p. 20). However,
it is important to point out that the municipalities’ responsibilities and
18 C. HUDSON ET AL.
how tightly these are controlled by national government have varied

over time. The governance of migration policy involves vertical (hier-
archical) steering in which the national government level is responsible
for formulating and deciding the main policy framework and goals; and
local (horizontal) cooperation with much of the practical work related to
migration handled at the local level and where the municipalities play a
key role (Lidén and Nyhlén 2014). In more recent years, this has been
further complicated by the introduction of market-based steering (Qvist
and Tovatt 2014).
National Level
Swedish Migration Agency (Migrationsverket)
The Swedish Ministry of Justice handles matters relating to migration and
asylum policy. It is responsible for the Swedish Migration Agency which
is the government agency tasked with applying the laws and carrying out
the activities decided on by the Riksdag (the Swedish Parliament) and the
Government with regard to migration policy. Its remit is to strive for ‘a
long-term, sustainable migration policy that safeguards asylum rights and,
within the framework of regulated immigration, facilitates mobility across
borders and promotes a needs-driven labour immigration, while utilizing
and considering the development effects of migration, and furthering
European and international cooperation’.2
Sweden’s migration policy comprises refugee and immigration policy,
return policy, support for repatriation and the link between migration and
development as well as global cooperation on these issues. The Swedish
Migration Agency makes decisions regarding work and residence permits,
as well as asylum and citizenship. With regard to the reception of refugees,
the Migration Agency provides housing and money for food to asylum
seekers, while they await a decision. A refugee who enters Sweden is either
temporarily placed in a Migration Agency accommodation facility or can
organize his/her own accommodation while waiting to be granted a resi-
dence permit or the issue of a deportation order. The average waiting
time for this decision was 15 months in May 2016 (Scholten et al. 2017).
Once a residence permit has been granted, it is primarily the job of the
Swedish municipalities and the Swedish Public Employment Services to
2 https://www.migrationsverket.se/English/About-the-Migration-Agency/Our-mission.
html.
be involved in the integration of the newly arrived refugee into Swedish

society. The Migration Agency pays compensation to the municipalities
to cover the costs of the introduction and settlement of newly arrived
refugees.
Swedish Public Employment Service (Arbetsförmedling)

The Swedish Government regards employment as the key to the integra-
tion of newly arrived people into Swedish society. Work is seen as not
only enabling newly arrived refugees to support themselves, but also to
develop Swedish language skills, learn about Swedish society, and to build
a wider social network. As mentioned earlier, reforms were introduced in
2010 that dramatically altered the decentralized character of integration
measures (Scholten et al. 2017; Wiesbrock 2011). In order to increase
the labour market focus of integration policies and to ensure a more
standardize approach across the country, responsibility was shifted away
from the municipalities. Instead the Swedish Public Employment Service
was given overall responsibility for the personalized two-year introduc-
tion programme for newly arrived refugees and their families. Once an
immigrant has been granted a residence permit, s/he is expected to partic-
ipate in this introductory programme. This combines language training
and civic orientation (provided by the municipalities) with labour market
activities. The aim is for the immigrant to learn Swedish, find a job and
become self-sufficient as quickly as possible.
In January 2018, new regulations were introduced that mean that
virtually the same rules and requirements apply to newly arrived immi-
grants as to all other jobseekers (Prop. 2016/17:175; Lag 2017:584). A
plan is drawn up for the activities the immigrant has to follow, such as
courses in Swedish and applying for suitable jobs. In common with other
jobseekers, newly arrived immigrants are required to submit an activity
report every month on what they have done and the progress made
(previously they were only required to do this every six months). If an
immigrant is participating fully in the programme, s/he may be entitled
to assistance from Swedish Social Security Agency (Försäkringskassan).
The individual must follow the activities plan, submit an activity report
and apply for suitable jobs in order to receive this benefit otherwise s/he
risks losing it.
The reform of the introduction programme was expressly designed
to enable immigrants to establish themselves faster in society, as well
as minimizing the risk that the conditions for this establishment might
20 C. HUDSON ET AL.
vary because of the room that the municipalities had previously had for
manoeuvre (Prop. 2009/10:60). The aims of the reform harmonized
with the broader ‘workfare’ ambitions of the centre–right government in
power at that time to increase employment amongst all groups in society.
A completely new feature was the ‘introduction guide’ (etableringslotsar)
who were to provide newly arrived immigrants with professional support
to facilitate their establishment in working life and enable them to become
self-sufficient as fast as possible. Although financed by the Swedish Public
Employment Service, most introduction guides are private actors rather
than public employees with the aim of allowing the newly arrived immi-
grants to choose among different suppliers. However, this ‘choice’ model
has been criticized by the National Audit Office as newly arrived immi-
grants have limited prerequisites for acquiring knowledge about different
introduction guide options thus limiting their ability to make a well-
informed choice (Riksrevisionen 2014). Further criticism has also been
raised concerning the quality and ‘seriousness’ of some of these private
sector providers (Lidén et al. 2019).
As Qvist (2016) has pointed out, the reform of the introduction
programme involved the somewhat paradoxical ambition of both greater
control and flexibility. Transferring responsibility to the Public Employ-
ment Service was seen as a way of increasing central control and ensuring
a more uniform supply of employment measures and equal quality stan-
dards across the country, at the same time it was argued that services
should be individualized and made more flexible. These changes disrupted
the collaborative tradition of decentralized decision-making in Swedish
local refugee reception and led to ‘reduced joint decision-making capacity
at the local level’ (Qvist 2016, p. 29). Contradictions in the constitu-
tion of the current system where responsibility is shared between several
different actors (national government agencies, the municipalities, and
publicly financed private actors) have been pointed out (Lidén et al.
2015) leading to coordination problems, shortcomings in accountability
and inefficiencies (Riksrevisionen 2014). Indeed, a recent OECD report
states that a stronger, more structured coordination is required between
the Public Employment Service and the municipalities to ensure coherent
pathways to employment and avoid duplication of services (OECD 2016).
Local Level
The County Administrative Boards (Länsstyrelser)
The County Administrative Boards are the extended arm of national
government at the regional level. They are responsible for and participate
in planning, organizing and implementing measures to assist newly arrived
refugees. This is done in collaboration with the municipalities, govern-
ment agencies, companies, organizations and voluntary associations. They
are tasked with improving and strengthening the municipalities’ prepared-
ness and capacity with regard to refugee reception and integration and
for unaccompanied minors. Since January 2011, the County Admin-
istrative Board has had an extended mandate to negotiate locally and
regionally with the municipalities and other relevant actors regarding
the reception of unaccompanied minors. It is charged with coordinating
national government efforts in the region through collaboration with
other authorities and organizations to ensure that the best interests of
the children are taken into account in decisions and other actions. The
County Administrative Board also has the task of supporting munici-
palities in the coordination of municipal activities such as Swedish for
immigrants and civic orientation. From 1 January 2017, this coordi-
nating role has been strengthened (SFS 2016:1363). In addition, it
allocates national government grants to municipalities to facilitate settle-
ment, increase municipal preparedness and reception capacity as well as to
provide, for example, introductory guidelines to help refugees orientate
themselves in Swedish society. It follows up the organization and imple-
mentation of measures to assist new arrivals and unaccompanied children,
both at regional and municipal level. It is responsible for deciding the
annual quota for each municipality (kommuntal ) within its region based
on the regional quota (länstal ) set by the Migration Agency (this is
discussed more below).
Municipalities (Kommuner)
Once an immigrant has been granted a residence permit in Sweden, it
is primarily the job of the Swedish municipalities and county councils,
along with the Swedish Public Employment Services, to be involved in
their integration into Swedish society. Although, as mentioned earlier, the
main responsibility for the introduction programme was transferred to the
Public Employment Service under the 2010 Act (Lag 2010:197), Swedish
municipalities still play an important role in the welfare and labour market
22 C. HUDSON ET AL.
integration of refugees and, in accordance with UN Convention on the

Rights of the Child (CRC), in providing schooling for children even while
they are awaiting a decision on a residence permit. Once a refugee has
been granted a residence permit, s/he must leave the Migration Board
accommodation facility as the legal responsibility for the refugee is trans-
ferred from national to local government. The municipality is responsible
for providing help to those immigrants who need assistance in finding
accommodation.
In 2016, the Reception of Newly Arrived Immigrants for Settlement
Act (Lag 2016:38), once again changed the situation for municipalities
so that they now have a mandatory, rather than a voluntary, respon-
sibility to accept immigrants. The aim with the new law is that newly
arrived refugees should be accepted for settlement in a municipality and
commence their entry into the labour market and the local commu-
nity as quickly as possible. From 2017 onwards, a quota is determined
for each year for each region (länstal ) by the Migration Agency, the
County Administrative Board then decides the quota for each munici-
pality (kommuntal ) within its region. These are set out in a Government
directive and the municipalities are required to accept those refugees
assigned to them. Regard is to be paid to the situation in each munici-
pality (such as the local labour market and availability of accommodation)
when deciding the number of refugees to be assigned. Although no
sanctions for non-compliance have been stipulated, there is a warning
that these may be introduced if necessary. These changes introduce a
new situation for the municipalities, for example, they are now required
to take into account the provision of accommodation for refugees in
their housing policies and programmes, although many face a housing
shortage (Länsstyrelserna 2017). Thus, they are put under greater pres-
sure to develop strategies for refugee reception and integration. Taken
together with the possibility for immigrants to choose their own place
of settlement, this has created considerable pressure on some municipal-
ities. Although the aim was to create a situation in which there was a
more equal reception of refugees throughout the country, the Official
Swedish Commission on the Reception of Refugees (Mottagandeutred-
ningen) set up in 2015 argues in its final report (SOU 2018:22) that the
high incidence of asylum seekers and immigrants with residence permits
organizing their own accommodation aggravates the uneven distribution
between municipalities. This opportunity is, therefore, currently under
review and there are proposals to limit immigrants’ possibilities to resolve

their own housing situation.
In addition to accommodation, Swedish municipalities are responsible
for providing language training in Swedish - Swedish for Immigrants
(SFI). This can either be organized by the municipality itself or by
contracting out such services to private actors. However, the content and
quality of SFI has been found to vary considerably between municipali-
ties (OECD 2014). Some municipalities offer a highly developed service,
including language training tailored to particular professions, whereas
others offer a much more limited service (Länsstyrelserna 2017). The
municipalities are also required to arrange courses in civic orientation that
provide an introduction to Swedish society. Dissatisfaction with the stan-
dard of these courses led the Government, in 2018, to commission a
review of their content with the ambition that they should better facili-
tate immigrants’ establishment in society and the labour market and that
greater emphasis should be put on informing about Swedish norms and
values (Regeringen 2018).
Once the immigrants have completed the introduction programme, if
they are unable to provide for themselves through, for example, employ-
ment, they are usually the responsibility of the municipality. This has led
some municipalities to engage in other integration efforts in addition to
their compulsory obligations. A common example is that municipalities
frequently provide the work experience placements that are administered
by the Public Employment Service as well as playing a key role in coor-
dinating actors from the civil sector with respect to work placements in
private businesses.
2.5 Implementation and Results

of Integration Policies
The idea that people who seek refuge in Sweden should be received
in a humanitarian and professional manner has been a long-held ideal
of refugee reception and integration work, and receiving refugees and
assisting with their integration into society has been a part of the Swedish
welfare state since the 1970s (Eastmond 2011; Wiesbrock 2011). In the
Swedish context, public debates about integration are centred on the obli-
gations of refugees and migrants to ‘integrate themselves’ into society,
living by Swedish values and norms, mastering the language and adjusting
to the Swedish way of life, thus conflating integration with the concepts
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necessary to cover it with some well-warmed and non-conducting
material and to have the room well warmed. If bed-sores are already
formed, they are to be treated according to ordinary surgical
principles. Antiseptic means should be in the foreground in the case
of the malignant bed-sore. It is to be remembered that the latter is a
gangrenous process, and, in so far as the formation of a line of
demarcation between the necrotic and the conserved tissue is
concerned, the ordinary expectant rules of surgery govern the case:
the water-bath appears to yield the best results. Ordinary bed-sores
yield readily to mechanical protection and stimulating ointments or
the balsam of Peru. Iodoform is recommended, but it produces
granulations of an indolent character as compared with those
obtained through the use of resinous ointments.
The warm bath is probably the most useful measure in acute

myelitis. In cases due to exposure I do not believe it can be applied
too soon. Its temperature should, in the beginning at least, not be
higher than about 88° F., and the duration about seven minutes. The
continued administration will depend on the immediate effect on the
patient, and the sittings can be ultimately prolonged to half an hour
or even longer. It should be administered once daily, and, when the
patient is not disturbed by the manipulation connected with its use,
even oftener. Cold baths are recommended by the Germans, but it
seems rather in the passive period of the disease than during its
active phase.
The management of the bladder trouble is one of the most critical

points in the treatment of most cases. The results of retention of
urine are more frequently the cause of a fatal issue than any other
single complication. Where there is complete retention continuous
catheterization is to be employed, as recommended by Strümpell.106
In other cases the bladder should be emptied thrice in the twenty-
four hours. The catheter is to be thoroughly disinfected, and if the
slightest sign of cystitis is noted the bladder should be washed out
with astringent and disinfectant solutions. The continuous irrigation
with a solution of corrosive sublimate, 1:2000, appears to give the
best results.
106 A. Nelaton's catheter is introduced into the bladder, and kept in place by strips of
adhesive plaster fixed to the inner aspect of the thighs. A perforated condom fixed to
the catheter, and then fastened to the inguinal region, is in my opinion a better
measure, especially in patients who have some motor power left. The catheter is
connected with a rubber tube, which should run on a decline in order to effect
complete drainage.
If there be a syphilitic taint present—and more particularly is this true

of cases where no other cause can be assigned—large doses of
iodide of potassium107 should be administered, and mercurial
ointment energetically applied, even to the point of salivation.
107 Here, if anywhere, the so-called heroic doses are applicable.
I am unable to say anything with regard to the local use of electricity

in the active period of the disease. Ascending currents are
recommended by Erb, weak currents of about five minutes' duration
being employed over the part supposed to be affected. In order to
secure sufficiently deep deflection of the current large electrodes are
applied. The use of galvanism and faradism on the affected
periphery, the former being preferred where atrophic, the latter
where anæsthetic conditions preponderate, is to be instituted early
and continued through the duration of the disease. The rules stated
in the section devoted to electro-therapeutics are to be followed. In
cases where the bladder or rectum are paralytic, these organs
should have galvanism applied to them by means of electrodes
shaped like catheters or sounds.
After the acute phase of myelitis is passed, the secondary period is

to be managed according to the principles laid down in the section
on the Treatment of the Sclerotic Processes.
THE CHRONIC INFLAMMATORY AND
DEGENERATIVE AFFECTIONS OF THE SPINAL
CORD.
BY E. C. SPITZKA, M.D.
The intimate dovetailing of parenchymatous and connective

substance in the spinal cord renders the determination of the precise
origin of a morbid process often difficult if not impossible. Whatever
the mode of origin, the typical termination of inflammatory and
degenerative spinal disorders is sclerosis—a condition in which the
essential nervous elements suffer diminution or destruction, while
the connective substance is either absolutely or relatively in
preponderance. The clinical result is nearly the same in all cases,
and with few exceptions depends less upon the histological
character than on the topographical distribution of the lesion. It is for
this reason that we shall follow rather the topographical than the
morbid histological principle in classification.
The chronic disorders of the spinal cord here considered have as a

common character the slow and progressive displacement of the
normal conducting nerve-tubes by a grayish, reddish, or otherwise
discolored tissue, which is firmer in texture than normal nerve-
substance. Minute examination shows that it is above all the myelin
of the nerve-tubes that is wasted or destroyed, while the axis-
cylinders may share in this dissolution, or, as in one form of
sclerosis, they may persist and even continue in their conducting
function. This increased consistency is found to be due to the
increase of connective-tissue trabeculæ and of the neuroglia. In
some cases this increase is active and absolute, like the increase in
certain phases of hepatic cirrhosis; in others it is rather relative and
passive, being merely a condensation of the connective framework
after the intervening elements have wasted away, just as the texture
of a compressed sponge is more compact than that of an expanded
one.
Crudely, the affections of the cord characterized by this change may

be divided into two great groups—the regular and the irregular. The
former are characterized by their limitation to special nerve-tracts.
Thus, in primary lateral sclerosis we find a special tract in the
posterior part of the lateral columns occupied by the lesion. A
number of spinal diseases with well-defined symptoms are due to
active morbid processes which similarly follow the normal distribution
of the great nerve-tracts of the cord, with the same, almost
mathematical, regularity with which the medullary white develops in
the fœtal and infantile cord. In another class of cases we find that the
same tracts are involved in like manner—not in the way of primary
disease, but through the interruption of the physiological continuity of
the nerve-tract by some other disease, to which the sclerosis is
therefore secondary. These are the so-called secondary
degenerations.
The irregular affections of the cord comprise cases in which the

sclerotic foci are either disseminated through the cerebro-spinal axis
in numerous foci, or diffusely involve a greater or lesser length and
thickness of the medullary cylinder, or, finally, extend in the
transverse plane completely or nearly so across the section area of
the cord at a definite level.
As the symptoms of the regular affections of the cord are by far the
most readily recognizable, and a preliminary knowledge of them will
facilitate the better understanding of the irregular forms, we shall
consider the former first. They may be subdivided into two groups.
The largest, longest known, and best studied consists of acquired,
the other, containing less numerous cases and varieties, and
rendered familiar to the profession only within the last decade,
comprises the spinal disorders due to defective development of the
cerebro-spinal and spinal-fibro systems.
Tabes Dorsalis.
SYNONYMS.—Locomotor ataxia and ataxy, Posterior spinal sclerosis;

Graue degeneration der Hinterstränge (Leyden), Rückenmarksdarre
(popular), Rückenmarksschwindsucht; Tabes dorsualis (Romberg);
Ataxie locomotrice progressive (Duchenne).
HISTORY.—Undoubtedly, this disease must have been observed by

the ancient masters of medicine, but their descriptions group
together so many symptoms of other organic as well as functional
diseases of the cord that it is impossible to obtain a clear idea as to
what special form they had in view when they spoke of tabes
dorsualis. This term was adopted by the German writers of the last
and the earlier part of this century as designating all wasting
affections of the cord; and it was not till Romberg in 1853 and
Duchenne in 1858 differentiated the characteristic clinical signs, and
Cruveilhier and Todd (1847) determined the distribution of the lesion
in the posterior columns, that the medical profession began to
recognize the distinctness of this the most common form of organic
spinal ailment.
At this time, when tabes dorsalis became recognized as a clinical

entity depending on sclerotic degeneration of the posterior segment
of the cord, the inco-ordination or ataxia manifested in the peculiar
gait of the patient was regarded as the most characteristic, essential,
and constant symptom of the disease. It was regarded as an axiom
in physiology that the posterior segment of the cord was subservient
to centripetal and sensory conduction, and nothing appeared to
follow more naturally than the conclusion that the patient exhibited
inco-ordination because, his sensory conduction being interrupted or
destroyed, he had lost the necessary gauge for judging of the
required extent and force of a given movement. Since then both
spinal physiology and pathology have undergone a profound
revolution. So far are we to-day from regarding anterior and motor or
posterior and sensory as convertible terms that we locate the most
important centrifugal tract of the cord behind the plane which divides
it into anterior and posterior halves, while the most recently
differentiated centripetal tract is represented by Gowers as lying in
front of it. It has been determined, through Türck, Bouchard, and
Flechsig and his pupils, that the posterior white columns of the cord
contain several systems of fibres, whose functions—where
determinable—are of an exceedingly complex nature. The elaborate
investigations of Charcot, Schultze, and Strümpell, made during the
past decade, have shown that the distribution of the diseased field in
the posterior segment is not uniform, but is most intense in special
areas. These were found to be affected with a remarkable constancy
and regularity. Almost coeval with this discovery came the
recognition of symptoms found in the earliest phases of the disorder
by Westphal, which, attributable as they were found to be to the
involvement of the special reflex mechanisms of the cord, enable us
to demonstrate the existence and extent of the disease at periods
which previously were not within the ken of the clinician. The
reproach which Leyden was justified in making, that most tabic
patients pass through the pre-ataxic phase of their disorder under
the diagnosis of rheumatism or some similar affection, can now no
longer be made. Our ability to recognize the advent of this disease
has reached such a degree of refinement that the question arises
whether we are always justified in alarming a patient who has a
prospect of remaining free from invalidating complications for many
years with the announcement of a disease which, above all other
spinal affections, is looked upon with dread as equally hopeless,
insidious, and distressing.
CLINICAL HISTORY.—The development of tabes dorsalis is typically

slow and its precise commencement usually not determinable. In
some cases this or that one of the characteristic symptoms of the
disease preponderates from the beginning, and continues
throughout the illness as a prominent feature; in others distinct
stages can be recognized, each marked by one or several symptoms
which were absent or slight in the other stages. In some cases the
progress of the affection is marked by episodes which are absent or
rare in other cases. As a rule, however, it may be stated that tabes is
a progressive affection, marked by pronounced temporary changes
for better or worse, which are often developed with astonishing
rapidity, and subside as quickly, terminating fatally unless its
progress be arrested by treatment or interrupted by some other fatal
affection. The latter is by far the more frequent termination in the
well-to-do class of sufferers.
For purposes of convenience we may consider the symptoms of the

earlier period of the illness as pre-ataxic, and those of the later as
the ataxic. It is to be remembered, however, that in the strictest
sense of the term there is usually some disturbance of co-ordination
even in the early period, while the symptoms of the pre-ataxic period
continue over the ataxic period, and may even become aggravated
with it. Often the patient does not himself suspect a spinal, or indeed
any nervous, disorder, and consults the physician either on account
of rheumatic pains, double sciatic neuralgia, bladder disturbance,
diminished sexual power, amaurosis, diplopia, or even gastric
symptoms, which on closer examination are revealed to be
evidences of tabes. The determination of the initial symptoms is
retrospective as a rule.
Of the subjective signs, one of the commonest, if indeed it be ever

entirely absent, is a tired feeling, particularly noted in the knees and
ankles. This sensation is compared to ordinary muscle-tire, but is
provoked by slight exertion, and not as easily remedied by rest.
Often a numb feeling is associated with it, although no objective
diminution of cutaneous sensation be determinable. This combined
feeling of tire and numbness, described as a going-to-sleep feeling in
the ankle, has indeed been claimed by one observer1 to be
pathognomonic of early tabes. Next in frequency, and almost as
universal, are peculiar pains: these are manifold in character and
distribution, but so distinctive as to alone suggest the existence of
the disease from the manner in which the patient describes them.
One variety, the lightning-like, is compared to a sudden twinge of
great intensity shooting through the limb. The sciatic and anterior
crural branches are the lines usually followed by this pain, but there
are cases where perineal and abdominal regions are affected. Often
the pain is so severe that the patient cries out or the limb is violently
contracted under its influence. It differs from rheumatic pain in the
fact that it is distinctly paroxysmal and that the intermissions are
complete; that it is not greatly aggravated by motion nor relieved by
rest, while the rheumatic pain is; that tabic pain is usually relieved,
and rheumatic pain aggravated, by pressure, while hyperæsthesia is
present with the former, and either absent or barely indicated with
the latter. The lightning-like pains are sometimes combined with
another form, which is even more distinctive in character. This form
does not affect the distribution of special nerves, but is found limited
to a small area which the patient is able to localize definitely: it may
not exceed a centimeter or two in diameter, and within this area the
pain is excruciating. It is either of a burning character or compared to
the firm pressure of a vise or heavy weight, or to the tearing, boring,
and jumping of a violent toothache.
1 Canfield, Lancet, 1885, vol. ii. p. 110.
While some patients escape these pains almost entirely,2 others are
tormented with them at intervals for years, their intensity usually
diminishing when the ataxic period is reached. There is little question
among those who have watched patients in this condition that their
pains are probably the most agonizing which the human frame is
ever compelled to endure. That some of the greatest sufferers
survive their martyrdom appears almost miraculous to themselves.
Thus, in one case the patient, who had experienced initial symptoms
for a year, woke up at night with a fulminating pain in the heels which
recurred with the intensity of a hot spear-thrust and the rapidity of a
flash every seven minutes; then it jumped to other spots, none of
which seemed larger than a pin's head, till the patient, driven to the
verge of despair and utterly beside himself with agony, was in one
continued convulsion of pain, and repeatedly—against his conviction
—felt for the heated needles that were piercing him. In another case
the patient, with the pathetic picturesqueness of invalid misery,
compared his fulminating pains to strokes of lightning, “but not,” he
added, “as they used to appear, like lightning out of a clear sky, but
with the background of a general electrical storm flashing and
playing through the limbs.”
2 I have at present under observation two intelligent patients (one of whom had been
hypochondriacally observant of himself for years) who experienced not a single pain,
as far as they could remember, and who have developed none while under
observation. Seguin mentioned a case at a meeting of the Neurological Society with a
record of but a single paroxysm of the fulgurating variety. Bramwell (Brit. Med. Journ.,
Jan. 2, 1886) relates another in which the pains were entirely absent.
Either while the pains are first noticed or somewhat later other signs
of disturbed sensation are noted. Certain parts of the extremities feel
numb or are the site of perverted feelings. The soles of the feet, the
extremities of the toes, the region about the knee-pan, and the
peroneal distribution, and, more rarely, the perineum and gluteal
region, are the localities usually affected.3 In a considerable
percentage of cases the numbness and tingling are noted in the little
finger and the ulnar side of the ring finger; that is, in the digital
distribution of the ulnar nerve. The early appearance of this symptom
indicates an early involvement of the cord at a high level. Some
parallelism is usually observable between the distribution of the
lightning-like pains when present and the anæsthesia and
paræsthesia if they follow them. With these signs there is almost
invariably found a form of illusive sensation known as the belt
sensation. The patient feels as if a tight band were drawn around his
body or as if a pressure were exerted on it at a definite point. This
sensation is found in various situations, according as the level of the
diseased part of the cord be a low or high one. Thus, when the lower
limbs are exclusively affected or nearly so the belt will be in the
hypogastric or umbilical region; if the upper limbs be much involved,
in the thoracic region; and if occipital pain, anæsthesia of the
trigeminus, and laryngeal crises are present, it may even be in the
neck. Correspondingly, it is found in the history of one and the same
patient: if there be a marked ascent—that is, a successive
involvement of higher levels in the cord—the belt will move up with
the progressing disease. This occurrence, however, is less
frequently witnessed than described. In the majority of cases of
tabes disturbances of the bladder function occur very early in the
disease. Hammond indeed claims that in the shape of incontinence it
may be the only prodromal symptom for a long period.4
3 In the exceptional cases where the initial sensory disturbance is marked in the
perineal and scrotal region I have found that the antecedent fulminating pains had
been attributed to the penis, rectum, and anal region; and in one case the subjective
sense of a large body being forcibly pressed through the rectum was a marked early
sign.
4 New England Medical Monthly, 1883.
I have under observation a patient who has been compelled to use

the catheter daily for years, who has gradual disappearance of the
knee-jerk and reflex iridoplegia, but who has presented no other
evidence of tabes during the year and a half he has been watched.
Among the exact signs of tabes, reflex iridoplegia and abolition of the
knee-jerk are probably the earliest to appear. It may be assumed
with safety that in ninety-nine out of a hundred cases both the
inability of the pupil to respond to light and the absence of the knee-
jerk will be found long before ataxia is developed. Cases are
recorded where no other positive signs were found, and no other
signs of the disease developed for a number of years,5 and others
where disappearance of the knee-jerk was the very first indication.
5 Westphal, also Tuczek, Archiv für Psychiatrie, xiii. p. 144.
The opinion of observers as to the frequency of double vision as an

early symptom of tabes is far from being unanimous. The majority of
writers speak of it as rare, but it is probable that this usually transient
symptom is forgotten by the patient, or because of its apparent
triviality escapes notice. The patient while looking at an object sees a
double image of the latter. This may last for a few seconds, minutes,
or hours, and rarely for a day or week.6 A distinct history of this
symptom was given by 58 out of 81 patients in whom I recorded the
oculo-motor signs. By far the most important of the exact prodromal
signs of tabes are two symptoms—one involving a special faculty of
co-ordination, the other the reflex movements of the pupil. One or
both of these must be present to justify the diagnosis of incipient
tabes.7 The disturbance of co-ordination consists in an inability of the
patient to stand steadily when his eyes are closed. The majority of
healthy persons when tested in this way may show a little swaying in
the beginning, but eventually they stand as steadily as they do with
open eyes, and there is no subjective feeling of uncertainty as to
falling. But the tabic patient exhibits oscillations, and makes efforts to
overcome them which, instead of neutralizing, usually aggravate
them and betray the great disturbance of his equilibrium. It is not as
if he swayed merely because he is uncertain of his upright position,
but as if some perverted force were active in throwing him out of it. It
is found to be a pronounced feature even in cases where the patient
with open eyes is able to walk nearly as well as normal persons, and
experiences no trouble in performing intricate evolutions, such as
dancing, walking a line, or even walking in the dark—faculties which
the patient is destined to lose as his disease progresses.8
6 It has been asserted that the severer and more persistent diplopias are found with
tabes dependent on syphilis.
7 Not even the absence of the knee-jerk ranks as high as these two signs. Aside from
the fact that this is a negative symptom, it is not even a constant feature in advanced
tabes.
8 It does not seem as if the disturbance of static equilibrium were due merely to the
removal of the guide afforded by the eyes, for it is noted not alone in patients who are
able to carry out the average amount of locomotion in the dark, but also in those who
have complete amaurosis. Leyden (loc. cit., p. 334) and Westphal (Archiv für
Psychiatrie, xv. p. 733) describe such cases. The act of shutting the eyes alone,
whether through a psychical or some occult automatic influence, seems to be the
main factor.
In most cases of early tabes it is found that the pupil does not
respond to light; it may be contracted or dilated, but it does not
become wider in the dark nor narrower under the influence of light.
At the same time, it does contract under the influence of the
accommodative as well as the converging efforts controlled by the
third pair, and in these respects acts like the normal pupil. It is
paralyzed only in one sense—namely, in regard to the reflex to light;
just as the muscles which extend the leg upon the thigh may be as
powerful as in health, but fail to contract in response to the reflex
stimulus applied when the ligamentum patellæ is struck. For this
reason it is termed reflex iridoplegia.9 It is, when once established,
the most permanent and unvarying evidence of the disease, and is
of great differential diagnostic value, because it is found in
comparatively few other conditions.
9 It is also known as the Argyll-Robertson pupil. Most of the important symptoms of
tabes are known by the names of their discoverers and interpreters. Thus, the
swaying with the eyes closed is the Romberg or Brach-Romberg symptom; the
absence of the knee-phenomenon, Westphal's or the Westphal-Erb symptom; and the
arthropathies are collectively spoken of as Charcot's joint disease.
In a number of cases ptosis of one or both eyelids is noted at an

early stage of the disease. It is usually temporary, and coincides as
to time with the diplopia, if present.
Patients presenting some or all of the subjective and objective

manifestations of tabes mentioned may continue in a condition of
otherwise comparative health, enabling them to attend to their
vocation for from one to twenty years, and it is not improbable that
the pre-ataxic period may extend over nearly a lifetime. In a less
fortunate minority of cases some of the most distressing evidences
usually marking the last stages of the disease are found developed
at the onset. Thus, cases are known where optic nerve-atrophy
preceded the true tabic period by ten or more years; others in which
trophic disturbances, manifested in spontaneous fractures of bones10
or violent gastric crises, or even mental disturbance, inaugurated
tabes dorsalis, instead of closing or accompanying the last chapter
of its history, which is the rule.
10 Berger, Deutsche medizinische Wochenschrift, 1885, 1 and 2.
The disturbance of co-ordination above spoken of as manifested in
the inability of the patient to stand well with his eyes closed is the
first step in the development of the characteristic ataxia which marks
the full-blown affection. The patient finds that he tires more and more
on slight exertion—not because his muscles are weak, but because
he has to make more voluntary effort than a person in health. He
finds that he stumbles easily—is unable to ascend and descend at
the curbstone or to walk over an irregular surface with ease. Going
down stairs is peculiarly irksome. “I would rather,” aptly said one
patient, “troubled as I am in walking, go a mile in the street than walk
up three flights of stairs; but I would rather go up six flights of stairs
than walk down one.” Soon the patient notices that walking in the
dark becomes more a feat of relative skill than the easy, almost
automatic, act it was in health. His vocation, if it was one involving
the use of the feet, becomes irksome, difficult, and finally impossible,
and in a number of cases the upper extremities are also involved.11
Delicate motions, such as those required in needlework, in writing,
and by watchmakers, musicians, opticians, and lapidaries, are
clumsily performed; even coarser movements, such as buttoning the
clothes and carrying a glass filled with water to the mouth, are
performed in an uncertain and clumsy manner. Meanwhile, the
disturbance of motion in the lower limbs progresses. Difficult as it
formerly was for the patient to stand on one foot or with both feet
together while the eyes were closed, he is now unable to do either
with the eyes open. He straddles in his walk, or, in order to overcome
the element of uncertainty involved in moving the knee-joint, keeps
this joint fixed and walks with short, stiff steps. If ordered to halt
suddenly while thus walking, the patient sways violently, and makes
movements with his hands or arms to recover his balance, in some
cases staggering and even falling down. He shows a similar
unsteadiness when told to rise suddenly from a chair or to mount
one, and it becomes impossible for him to walk backward. Later on,
it will be found that his feet interfere in walking. He has lost the
power of gauging the extent and power of his motions to such a
degree that he may actually trip himself up. To neutralize in some
way this element of uncertainty of his steps, the patient is compelled
to exaggerate all his ambulatory movements, and there results that
peculiar gait which was the first symptom directing attention to the
disease to which it is due. The feet are thrown outward, and violently
strike the ground; the heel touches the latter first, and the patient
appears as if he were punishing the ground and stamping along
instead of walking. The reason for his adopting these tactics are
twofold. In the first place, he has a subjective sense of walking in a
yielding substance, as if on a feather bed, air-bladders, cushions, or
innumerable layers of carpet, and he therefore makes efforts to
touch firm bottom. In the second place, his motor inco-ordination, in
so far as it is not the result of anæsthesias, is greatest in those
segments of his limbs which are farthest removed from the trunk,
and which, enjoying the greatest freedom of combined motion, are
also most readily disturbed. His uncertainty is therefore greater in the
toes than in the ankle, greater in the ankle than in the knee, and
greater in the knee than in the thigh: he prefers to touch the ground
with the heel to touching it with the toes, and to move his limb in the
hip than in the knee-joint. As the patient advances in life even this
limited and clumsy form of locomotion becomes impossible: he takes
to his bed, and it is found that he loses all sense of the position of his
lower and occasionally of his upper limbs. He is unable to tell which
limb overlies the other when his leg is crossed—unable to bring one
limb in parallel position with another without the aid of his eyes. If
told to touch one knee or ankle with the toes of the other side, his
limb oscillates around uncertainly, and makes repeated unskilful
dashes at the wrong point, and ultimately all but the very coarsest
muscular co-ordination appears to be lost, even when the
supplementary aid of the eyes is invoked.
11 Cases in which the upper extremities are intensely involved in the beginning are
uncommon, and those in which they are more intensely involved than the lower, or
exclusively involved, may be regarded as pathological curiosities.
Together with this gradual impairment and abolition of co-ordination,

which has given the name of locomotor ataxia to the disease, but not
always in that strict parallelism with it on which Leyden12 based his
theory of inco-ordination, the sensory functions proper become
perverted and impaired. Usually the determinable anæsthesias are
preceded by subjectively perverted sensations, such as the
numbness already referred to, or even by hyperæsthesia. Usually, all
categories of cutaneous sensation, whether special or pathic, are
impaired in advanced tabes; the points of the æsthesiometer are not
readily differentiated; the patient is unable to correctly designate the
locality which is touched or pinched; the pain-sense is occasionally
so much blunted that a needle may be run through the calf of the leg
without producing pain, and in some cases without being
appreciated in any form. Even if the pain-sense be preserved, it will
be found that its appreciation by the patient is delayed as to time.
Not infrequently bizarre misinterpretations are made of the
impressions acting on the skin. One of these, the feeling as if the
patient were standing on carpet, cushions, or furs, whereas he may
be standing on stone flagging, has already been mentioned as a
factor in the disturbed locomotion of the patient. In the later period,
numerous perversions of this kind are noted: to one of these, already
mentioned by Leyden, Obersteiner has called renewed attention. It
consists in a confusion of sides; the patient when pricked or touched
on one foot or leg correctly indicates the spot touched, but attributes
it to the wrong side.13
12 Klinik der Rückenmarkskrankheiten, Band ii.
13 Allochiria is the term applied by Obersteiner. Hammond has offered an explanation,

which, as it is based on the assumption of altogether hypothetical nerve-tracts, and
not in any sense accords with positively established facts, is more properly a subject
for consideration in a theoretical treatise.
While it may be affirmed, as a general proposition, that the tendency

of the tabic process is to abolish sensation below the level of the
disease, there are noteworthy exceptions, not only in individual
cases, but with regard to certain kinds of sensation; nor do the
different kinds of sensation always suffer together. Thus, the pain-
sense may be blunted and the contact-sense preserved, or, more
commonly, the latter blunted and the former exaggerated, so that the
unfortunate patient, in addition to being debarred of the useful
varieties of sensation, those of pressure and space, has the painful
ones exaggerated, as a hyperalgesia. According to Donath,14 the
temperature-sense is usually blunted in tabes, and a greater degree
of heat or cold can be borne without discomfort than in health; but in
about two-sevenths of the cases studied there was increased
sensitiveness to heat, and in one-seventh to cold. One of the
commonest manifestations is delayed conduction. This interesting
phenomenon has been especially observed in that phase of the
disease where tactile perception is beginning to be blunted. If the
patient be pricked with a pin, he feels the contact of the latter at the
proper moment as a tactile perception, and then after a distinct
interval, varying from one to four seconds, his limb is suddenly
drawn up and his face contorted under the influence of an
exaggerated pain. This fact furnishes one of the chief grounds for the
assumption that there are distinct channels for the transmission of
pain and tactile perception in the cord, and that they may be involved
separately or with different intensity in the disease under
consideration. In some advanced cases it is found that not only the
transmission of pain-appreciation is delayed, but that there are after-
sensations recurring at nearly regular intervals of several seconds,
and accurately imitating the first pain-impression.
14 Archiv für Psychiatrie, xv. p. 707.
To what extent the muscular sense is affected in tabes at various

stages of the disorder is somewhat in doubt. Strümpell15 by
implication, and other writers directly, attribute the inco-ordination
observed on closing the eyes to the loss of the muscular sense. As
this symptom is also observed in patients who when they lie on their
backs are able to execute intricate movements notwithstanding the
exclusion of the visual sense, and as their uncertainty in an early
stage is not always with regard to the position of their limbs nor the
innervation of individual or grouped muscles, it seems inadmissible
to refer the Romberg symptom16 to the loss of muscular sense alone.
15 Lehrbuch der Speciellen Pathologie und Therapie, p. 193, vol. ii.
16 It should be designated as static ataxia, in distinction from locomotor or motor

ataxia, which is manifested in unskilled movements.
The important part played by eye symptoms in the early stages of
tabes has been already referred to. Reflex iridoplegia is one of these
early and persisting features; it is sometimes complicated with
mydriasis, and occasionally with paralysis of accommodation of one
eye. In the majority of my cases there was spinal myosis, often of
maximum intensity; in a large number there was in addition
irregularity of the outline of the pupil; and where there was mydriasis
I found it to be quite symmetrical, in this respect differing from the
experience of Müller17 and Schmeichler.18
17 Centralblatt für die Gesammte Therapie.
18 Loc. cit.
Atrophy of the optic nerve is a common and sometimes, as stated,

the initial symptom of tabes. It is rarely found in its incipient phase in
advanced stages. The patient who escapes involvement of the optic
nerve in the pre-ataxic stage is very apt to escape it altogether. It is
more frequently found either to precede the pre-ataxic period by
months and even years, or to develop during this period, leading to
complete atrophy in the ataxic period, and sometimes before. Erb
calculates that 12 per cent. of tabic patients have optic-nerve
atrophy; he probably includes only such cases in which the atrophy
was marked or led to amblyopia. Including the lesser degrees of
atrophy, it is found in a larger number of patients. Schmeichler
claims as high as 40 per cent.19 If we regard those cases in which
there is noted progressing limitation of the color-field of the retina as
beginning optic-nerve atrophy, the majority of tabic patients may be
said to have some grade of this disorder. The ophthalmoscopic
changes are quite distinctive: at first there is noted a discoloration of
the papilla and apparent diminution of the number of arterial vessels;
the veins then become dilated; and finally the papilla becomes
atrophied, the vessels usually undergoing a narrowing after their
previous dilatation. In the first stages of this process visual power is
not gravely impaired, but as soon as shrinkage has set in visual
power sinks rapidly to a minimum, decreasing till only quantitative
light-perception remains. This limited function usually remains
throughout, but in a few cases complete amaurosis ensues. As the
field of vision becomes diminished, the concentric extinction of
quantitative perception is preceded by concentric extinction of color-
perception, the color-field for green being the first to suffer; red
follows, and blue remains last.
19 Archives of Ophthalmology and Otology, 1883.
In a large number of cases the only symptoms attributable to a

disturbance of the cerebral functions are those connected with the
motor relations of the eyeball and pupil, and the function and
appearance of the optic nerve. The special senses other than those
of sight and touch are rarely affected. Sometimes there is obstinate
tinnitus, exceptionaly followed by deafness, attributed to atrophy of
the auditory nerve. The development of symptoms resembling those
named after Ménière is not referable with certainty to a disturbance
of the same nerve.
The sexual functions become involved in all cases of tabes sooner or

later. In the majority of cases there is a slow, gradual extinction of
virile power; in a large minority this extinction is preceded by irritative
phenomena on the part of the genital apparatus. Some patients
display increased sexual desire and corresponding performing
powers, but mostly they suffer from erections of long duration which
may be painful, and loss of the normal sensations attending the
sexual orgasm. There is no constant relationship between the
intensity of the general affection and the diminution of sexual power.
It is retained to a limited degree by patients who are barely able to
walk, and it may be entirely destroyed in those who have but entered
the initial period.
The bladder disturbance,20 which in some forms is usually found

among the initial symptoms, is always a marked feature in the ataxic
period. Usually, there is a frequent desire for micturition, with more or
less after-dribbling; sometimes there is retention, alternating with
involuntary discharge; complete incontinence may close the scene
through the channel of an ensuing cystitis and pyelitis. With the
incontinence of urine there is usually found obstinate constipation,
which may be varied by occasional spells of incontinence of feces.
The crises of tabes often complicate these visceral symptoms.
20 Contrary to what might be anticipated from the topographical nearness of the
vesical and genital centres in the cord, the disturbances of bladder function and virile
power do not go hand in hand.
The reflex disturbances are among the most continuous evidences

of the disease. Of two of these, the disappearance of the patellar jerk
or knee-phenomenon and the inability of the pupil to react to light,
we have already spoken when discussing the initial period.
Practically, it may be claimed that both are always found in typical
tabes. It has been claimed that the patellar jerk may be exaggerated,
or even that its disappearance is preceded by exaggeration. As this
disappearance usually occurs extremely early in the pre-ataxic
period, it is difficult to follow the deductions of those who claim to
have watched an alleged earlier phase of exaggeration. It is more
than probable that cases of combined sclerosis, in which the lateral
columns were affected together with or earlier than the anterior, have
been mistaken for typical tabes. Here, it is true, the jerk is first
exaggerated through the disease of the lateral column, and later
abolished as the lesion in the posterior reflex arch progresses and
becomes absolute.
Other tendinous reflexes21 suffer with the knee-jerk in the peripheries

corresponding to and below the involved level of the cord. The
cutaneous reflexes are usually abolished, but may be retained in
advanced stages of the disease. The same is true of the cremaster
reflex.
21 Whether the tendon phenomena are true reflexes or not is a question still agitating
physiologists. Opinion inclines in favor of their reflex nature, and, pathologically
considered, it is difficult to regard them in any other light.
Opinion is divided as to the electrical reactions in tabes dorsalis.

That qualitative changes never occur in uncomplicated cases all
authorities are agreed, but while Strümpell and other modern writers
claim there is no change of any kind, a number of careful
investigators have found an increased irritability in the initial period,
particularly marked in the peroneal group of muscles (Erb). In my
own experience this is frequently the case, where lightning-like pains
are the only subjectively distressing symptoms complained of.
While the symptoms thus far considered as marking the origin and
progress of tabes dorsalis are more or less constant, and although
some of them show remarkable remissions and exacerbations, yet
may in their entity be regarded as a continuous condition slowly and
surely increasing in severity, there are others which constitute
episodes of the disease, appearing only to disappear after a brief
duration varying from a few hours to a few days: they have been
termed the crises of tabes dorsalis. These crises consist in
disturbances of the functions of one or several viscera, and are
undoubtedly due to an error in innervation provoked by the
progressing affection of the spinal marrow and oblongata. The most
frequent and important are the gastric crises. In the midst of
apparent somatic health, without any assignable cause, the patient is
seized with a terrible distress in the epigastric region, accompanied
by pain which may rival in severity the fulgurating pains of another
phase of the disease, and by uncontrollable vomiting. Usually, these
symptoms are accompanied by disturbances of some other of the
organs under the influence of the pneumogastric and sympathetic
nerves. The heart is agitated by violent palpitations, a cold sweat
breaks out, and a vertigo may accompany it, which, but for the fact
that it is not relieved by the vomiting and from its other associations,
might mislead the physician into regarding it as a reflex symptom. In
other cases the symptoms of disturbed cardiac innervation or those
of respiration are in the foreground, constituting respectively the
cardiac and bronchial crises. Laryngeal crises are marked by a
tickling and strangling sensation in the throat, and in their severer
form, which is associated with spasm of the glottis, a crowing cough
is added.22 Enteric crises, which sometimes coexist with gastric
crises, at others follow them, and occasionally occur independently,
consist in sudden diarrhœal movements, with or without pain, and
may continue for several days. Renal or nephritic crises are
described23 as resembling an attack of renal colic. The sudden

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Local Integration of Migrants Policy:

European Experiences and Challenges

More information about this series at

ISSN 2523-8248 ISSN 2523-8256 (electronic)

“A unique volume providing deep insights into practices of migration

comparative analysis of European practices and experience of handling

1 New Challenges in Local Migrant Integration Policy

2 Between Central Control and Local Autonomy:

3 The Norwegian Case: Integration Through Local

4 Finland’s Immigration Policy: State Objectives, Local

5 The Swiss Rationale of Integration Policies: Balancing

6 Migration in the Netherlands: Threats

7 Germany: From Denied Immigration to Integration

8 Ireland’s Evolving Migrant Policy: Recurring

9 Reception of Asylum Seekers and Refugees in France:

10 Immigration and Integration Policies in Poland:

11 Slovenian Migration Management at the Local Level 201

12 Local Integration Policy of Migrants in Croatia: In

13 Romania’s Policy of Migration and Integration:

14 Challenges of Immigrant Integration in Spanish Local

15 Internal Geopolitics and Migration Policies in Italy 261

16 Public Opinion on Migration and the Role

17 Integrating Immigrants: Capacities and Challenges

18 Conclusions: An Overview of Local Migrant

Giuseppe Bettoni Professor of Geography at the University of Rome

Jochen Franzke Co-editor of the Palgrave Studies in Sub-National

of refugees at the local level (2018). He participated in several projects

Monnet Chair. Prior to that, he was working in various higher education

of violence, and the intersections of race and gender as well as planning

Coordinator on behalf of the Warsaw Family Support Centre of the

ADA Asylum Seeker Allowance in France

CRHH French Regional Housing and Accommodation Committees

IMISCOE International Migration, Integration and Social Cohesion

SER Dutch Social and Economic Council

Fig. 3.1 Increase in immigrant population (immigrants

Table 3.1 Immigrants and Norwegian-born to immigrant parents,

New Challenges in Local Migrant

Jochen Franzke and José M. Ruano de la Fuente

This book mainly examines new challenges and approaches in national

© The Author(s) 2021 1

After a long development process, the European Union finally granted

1.1 Multi-Level Governance

The focus of this volume is on the developments in integration policy

dimension thesis, which argues that all policies adopted by municipali-

1.2 The Role of Local

1.3 Dimensions of Local

identities. In this model, a multicultural society viewed as desirable and

1.4 About This Book

within and amongst different actors, such as local administrations, local

includes the traditional forms of migration and integration policy as well

Entzinger‚ H. B.‚ & Biezeveld‚ R. L. (2003). Benchmarking in Immigrant Inter-

Between Central Control and Local

Christine Hudson, Katarina Giritli-Nygren, Gustav Lidén,

© The Author(s) 2021 11

2.2 Background: Swedish Migration

family reunification was lowered to apply to children under the age of 18

2.3 Contemporary National Migration

(Riksrevisionen 2017), there have been enormous changes in migration

2015). It was argued that, in order to ensure better organization of

country of origin is re-evaluated. For those granted refugee status, if they

2.4 Distribution of Responsibilities

how tightly these are controlled by national government have varied

be involved in the integration of the newly arrived refugee into Swedish