This article examines organized efforts by citizens to provide medical aid to unauthorized migrants in Germany. A case study of an activist organization in Berlin highlights how prevailing forms of governance through citizenship are disrupted. Three major themes are explored. First, historical contingencies and policy realities explain why, given examples of grassroots protest by migrants in other settings, efforts in Germany have been driven primarily by citizens. Second, migrants’ biolegitimacy shapes specific ideas of relative deservingness. As a result, advocacy for some groups, such as survivors of torture or refugees from specific geopolitical settings, is more highly valued than that which addresses needs of unauthorized labor migrants. Finally, although their sustained efforts have resulted in challenges to policy and called into question prevailing notions of citizenship, medical activist organizations have become increasingly institutionalized, which may jeopardize their goals. As this case illustrates, the distinctive ethics associated with providing medical care has the ability to disrupt the scaling of citizenship by the state by treating noncitizens – especially ‘illegal’ noncitizens – ostensibly as citizens, thus protesting citizenship as the exclusive organizing principle of German society.