Connecting care: Understanding the relational dimensions of supporting migrant children and young people living with sickle cell disease

Migrant children and young people (CYP) living with sickle cell disease (SCD) in the UK face persistent, intersecting barriers to care. While existing research often maps these barriers, less is known about how service providers navigate them in practice. This study draws on Tronto’s ethics of care framework (1993; 2013) to examine how healthcare professionals and third-sector organisation workers enact care for migrant CYP living with SCD within a fragmented and unequal health system. We conducted semi-structured interviews with 23 service providers, comprising 14 healthcare professionals and 9 third-sector workers. We analysed the data using constructivist grounded theory co-produced with Public and Patient Involvement advisors. Using Tronto’s five phases of care – caring about , caring for , care giving , care-receiving , and caring with – we examine how service providers described identifying needs, assuming responsibility, navigating practical and institutional challenges, responding to feedback and creating solidarity amid systemic constraints. Our findings highlight the informal, relational, and moral labour service providers undertake to bridge gaps in provision. This work is characterised by empathy and advocacy but is often unsupported by formal structures. While service providers recognised that care should be a shared, socially shaped process, they often found this difficult to enact within fragmented systems, leaving care precarious, ad hoc, and emotionally demanding. This underscores the limits of relational care in the absence of systemic support. We argue that, although Tronto’s framework offers a valuable lens for understanding everyday ethics, sustainable and equitable care for migrant CYP living with SCD requires systemic change that embeds care as a collective, institutional responsibility. • Explores care for migrant CYP with SCD using Tronto’s ethics of care framework • Reveals how service providers go beyond formal NHS roles to support families • Identifies gaps between personal care efforts and systemic healthcare structures • Highlights emotional and structural costs of discretionary, relational care • Calls for justice-based care across statutory and third-sector systems.