Universal notions of a "right to health" for unauthorized migrants operate together with incongruous state and international policies. These ambivalent policies demand ethnographic attention, since they have resulted in a two-tiered system in host countries and foster short-term, improvisational remedies. Medical care for unauthorized migrants is typically left in the hands of non-governmental organizations (NGOs) and permitted under the guise of sympathy and generosity rather than anchored in policy. This paper draws upon ethnographic fieldwork in Germany to present the viewpoints of physicians engaged in medical humanitarianism and discuss the complications associated with filling access gaps through NGOs. It explores the range of motivations-political, religious, and humanitarian-that drive physicians to provide care to marginalized populations. In recent years, I argue that NGO demands upon the state have moved from requests to decriminalize medical aid to demands for compensation for the significant amount of services they provide. Finally, as improvisational medical aid has shifted from being an exception to becoming the rule, volunteers have become frustrated by serving as "stopgaps" while simultaneously arguing for systemic change. The paper examines physicians' roles as gatekeepers and the moral/ethical dilemmas that arise, illustrating how NGO practices underscore neoliberal forms of govemmentality. Copyright © 2011 by the Society for Applied Anthropology.

unauthorized migrants Nongovernmental organizations Medical humanitarianism Germany

government Germany marginalization fieldwork neoliberalism nongovernmental organization