Maverick Citizen


Double jeopardy: Addressing the structural drivers of migrant labour health 

Ethiopian migrants rescued off the coast of Libya pray aboard the Geo Barents, a rescue vessel operated by Doctors Without Borders on June 14, 2021. As the world felt like it was emerging from Covid in early 2021, there was a new surge in migration across the Central Mediterranean. At the same time, European countries locked down their borders, and the EU border agency began to increasingly rely on and collaborate with the Libyan Coast Guard (LCG) to keep the migrants from European shores, giving the LCG assistance in intercepting migrant boats. As a result, this year has seen a dramatic increase in the deadliness of these crossings. Amid these pressures, humanitarian ships have slowly begun resuming their operations. (Ed Ou/The Outlaw Ocean Project)

International Migrants Day, December 18th, provided an opportunity for a rethink and reset of how societies treat a vital asset - that starts with making the invisible visible.

Among the many fault lines of inequality exposed by the Covid-19 pandemic, the risks, inequalities and vulnerabilities experienced by migrant workers have received scant attention. 

The escalating ‘othering’ of migrants as people who represent risk rather than opportunity, people to be feared rather than welcomed, has a long history, including during times of infectious disease epidemics. Whether looking at outbreaks of smallpox, bubonic plague, sexually transmitted infections (including HIV) or influenza, the politics and policies of blame towards migrants have a long and shameful history

The ongoing negative framing of migration contributes to the side-lining of the rights, needs and vulnerabilities of migrants themselves – including in relation to their health.  Yet migrants are vital to the economies of both sending and ‘host’ countries and play a significant role in the global economy. 

In 2018, migrant workers sent $689 billion in remittances worldwide of which roughly 77% went to developing countries. Economies of some regions depend on migrant labour, including due to labour shortages resulting from ageing populations, while others rely heavily on remittances sent by the migrants. 

South Asian migrant workers account for roughly 20% of all remittances received globally.  In 2019 Pakistani migrant workers sent home US$21.84 billion, comprising around  7.9% of the country’s GDP – similar contributions to GDP are seen in Nepal and Sri Lanka too. With rapidly changing demographics globally, the benefits of orderly migration are becoming more obvious, with the demand for and number of labour migrants set to grow

Labour migrants are defined by the International Labour Organization (ILO) as “​​all international migrants who are currently employed or unemployed and seeking employment in their present country of residence”. There are an estimated 169 million international labour migrants globally, representing over 60% of all migrants, and approximately 5% of the global labour force, a figure that rises substantially in some areas of the world – for example, the countries of the Gulf Cooperation Council have one of the highest levels globally of non-nationals in their employed workforce and Qatar is the GCC country with the highest migrant labour participation rate, at 95%. 

Industries and services, including health and social care, are frequently dependent on the contributions of migrant workers, not only in the Gulf countries, but in many settings around the world.  

The ILO estimates that 58% of labour migrants are male – although the gender breakdown varies by location and occupation.

The SELMA research project*

 Over the past four years we have been researching the health and wellbeing of labour migrants travelling between Pakistan and the Gulf countries. The large majority of these migrants are men, and they are relatively young (median age is 33 years) – they are often referred to as “single male labourers” irrespective of their marital status, and they travel alone as immigration policies often prohibit accompanying family members unless the men are classed as ‘professional’ when they accorded different immigration status on the basis of their salary.  

Our (yet to be published) research in Pakistan and Qatar found that policies to protect the health and wellbeing of these men are seriously deficient in terms of conforming to global recommendations, and policies which do exist largely fail to consider human rights and equity and have low implementation potential. While our research focused on one sending and one host country, we believe that the findings are applicable more widely.

The current pandemic has laid bare both how vital these men (and women) are to the lives we all lead but also how the environments we collectively facilitate, benefit from and yet ignore contribute to an increased risk of infection for labour migrants – driven by a combination of poor working conditions, overcrowded housing, and inadequate access to health services. 

In Singapore, for example, Jo Teo, the Minister of Manpower (sic) in addressing the precipitous rise in COVID-19 infections among labour migrants in early 2020 noted “very poor and unhygienic” living conditions under which “many foreign workers lived”. She further remarked that “To save costs, their employers would often house them at the very sites where they worked, which were unregulated.” 

Despite the vast numbers of labour migrants, their economic importance to both sending and host countries, and the evidence of the health inequities they suffer, this group of migrants receives relatively little attention from academics or national policy-makers. For example, in a recent bibliometric analysis only 6% of all papers published on migrant health were focused on labour migration. And a systematic review of structural interventions to address the health of labour migrants found only two published studies. 

This knowledge gap reflects both a general neglect of attention to and research on the structural and social sphere of health in general as well as of labour migrants in particular. The evidence gap also highlights the very real challenges of research in this area – coupled with the challenge of implementing policies for improving the social and structural conditions under which labour migrants live.  Yet this deficit has direct consequences on the health and rights of people. 

As one of the participants in our public engagement art programme working with labour migrants in Pakistan (see picture, and accessible here) put it: 

‘Some of us got very sick and injured, but no health support was provided. We ate discarded waste food off the streets. We had very difficult times for 3 months. People left before, as they were not able to support their family.’’

Labour migrants are too often considered as a source of expendable and replaceable labour rather than rights-holders contributing to the economic and social fabric of both sending and receiving countries. But as Minister Teo reflected, ‘I hope the COVID-19 episode demonstrates to the employers and wider public that raising standards at worker dormitories is not only the right thing to do, but also in our own interests. We should be willing to accept the higher costs that come with higher standards.’ 

And in a later speech she went on to thank such workers, concluding that ‘We have a responsibility to these workers and we will do everything we can to take care of them.’

On International Migrants Day and beyond it is time to ensure that the invisible community of lonely labourers is heard, their social and economic conditions improved, and their health, dignity and rights are respected. DM/MC

Kent Buse, Director, Healthier Societies Programme, The George Institute for Global Health, Imperial College London, UK; Fauziah Rabbani, Associate Vice Provost, Research, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan; Sarah Hawkes, Director, Centre on Gender and Health, Institute for Global Health, University College London, UK. The authors declare no conflicts of interest. This research is supported by the Wellcome Trust.

*The SELMA project set out to understand what policies were in place to protect migrant/refugee health. Through the lens of two disparate migration health contexts; migrant, refugee and asylum systems in the UK, and male labour migration from Pakistan into the Gulf Cooperation Council, SELMA provides a rich and textured image of the structural drivers of health and the extent to which gender and gender norms shape the health and wellbeing of migrant and refugee communities.

The works are presented in virtual exhibitions that are the result of two lively public engagement projects run in Pakistan and the UK respectively. Through these exhibitions, we encourage you to see beyond the construction of migrants and refugees as reducible to their migratory status and to encounter the diverse and dynamic realities of migration.


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