Viewpoint by Mahinda Seneviratne
SYDNEY (IDN) — Disruptions from war, impacts of climate, and the growing inequities in wealth distribution are some main factors that drive over 160 million international migrant workers to seek work for a living in overseas countries. The COVID-19 pandemic has magnified the 3-D jobs (dirty, dangerous, and difficult) that migrant workers face in their host country while exposed to precarious work.
These conditions regularly expose these migrant workers to an unequal risk to their health and safety at work within and in host countries. From emergency physicians, other health care workers, and quarantine guards in the COVID-19 frontlines to the unrecognised essential workers in retail, hospitality, transport, agriculture, construction, and several other industries, migrant workers have borne an unequal share of illness and deaths. According to the limited published research now available from several countries where the necessary data was gathered.
Expert practitioners from four continents explored the impact at a special session on migrant workers’ health at the 32nd Congress of the International Commission on Occupational Health (ICOH) in early February. The Congress is the major triennial gathering of the world’s leading occupational health professionals to share knowledge, research, and practical experience. The event planned for April 2020 in Melbourne was postponed to a virtual Congress with the revised theme “Sharing solutions in Occupational Health through and beyond the Pandemic”.
Various emerging workplace health issues such as the gig economy, climate change and heat stress, and the increasingly unpredictable future of work with rapid technological, demographic and social changes were given close attention at the Congress. There was renewed concern about the unknown toll of long-latency cancers and other serious diseases from exposure to the increasing number of hazardous substances in workplaces.
Silicosis, the long-known occupational disease that has claimed thousands of lives each year in India, China, South Africa, and several other low to middle-income countries for decades, was addressed at several sessions of the Congress. This deadly respiratory dust disease gained renewed attention before the pandemic after several artificial stone fabrication workers, mainly overseas-born migrants, in Australia and other high-income countries such as Spain, Italy, Israel, and the USA were diagnosed with an accelerated type of this incurable illness.
“The 164 million international labour migrants globally are at a greater risk of work-related illness, including psychiatric and physical morbidities as well as workplace accidents and injuries,” said Professor Sally Hargreaves of the Migrant Health Research Group at the University of London, who recently reviewed and analysed studies on the occupational health and safety of migrant workers. She expressed concerns that the health of migrant workers and its governance is politicised and remains at the margins of policymaking.
This is evident in several high-income countries with a large proportion of migrant workers in its workforce for several decades, where calls for focussed policy and programs on migrant worker health and safety have been largely ignored or only given ineffective piecemeal attention.
Dr. Hargreaves believes such attitudes are a mistake because “investment in the health of migrant workers aligns with the host country’s commitments to promote health and can also result in gains in productivity as well as in public health.”
With the FIFA World Cup soccer tournament kicking off later this year in Qatar, the toll of migrant construction workers in the deadly desert heat could be an own goal for the hosts, who have avoided close attention to their unsafe and unhealthy working conditions.
An Amnesty International report ‘In the prime of their lives’, released at the height of the pandemic’s second wave in 2021, drew attention to Qatar’s failure to investigate, remedy, and prevent migrant workers’ deaths. The human costs of building airconditioned stadiums over a long period in hot afternoon heat were evident, for example, in the association with excess cardiovascular deaths among migrant Nepali construction workers. The local kafala system of migrant-employer contracts requires those sponsoring foreign workers to place tight restrictions on changing employers. This traps foreign workers in abusive or exploitative work conditions in construction, domestic, and other service sectors with predominantly low-skilled migrant workers.
Migrant workers who perform the harsher outdoor manual labour tasks in the wealthy Persian Gulf countries are primarily from the Indian subcontinent, the largest source of migrant workers globally (south to south migration). Dr. Radheshyam Krishna KC, Migration Health Officer from the International Organisation of Migration (IOM) in Kathmandu, spoke on the cross-border migration of Nepalese workers to India, which has occurred for several decades. Cross-border migration for people from the western part of Nepal is one of the surviving strategies, and this kind of migration is also facilitated by the 1950s India-Nepal friendship treaty. He estimated that there were 3-4 million Nepalis in formal and informal sectors in India alone and drew attention to “… the high rate of children, girls, and women trafficked to sexual and other exploitative work without any legal recourse”.
Vaccine nationalism has contributed to less than 10% of vaccination against COVID-19 in the African continent, where large populations regularly move across borders in search of work. “Impacts of transport disruptions, border restrictions, vaccination passports and expensive tests and quarantine costs added to the burden of stigma and discrimination faced by affected migrant workers in Africa”, noted Dr. Barry Kistnasamy, Compensation Commissioner of the Department of Health in South Africa.
Social compacts such as the ILO’s Decent Work, one of the UN’s Sustainable Development Goals by 2030, can play an important role through multilateral agencies such as WHO and the international social security body—ISSA. Dr. Kistnasamy called for collaboration across migrant-sending, transit, and receiving countries so that culturally and linguistically appropriate information is available within migrant communities. This should be at point of exit and entry into countries and within their health, employment, and social services.
In several host countries, political opportunism, racist undertones, and other short-term priorities have marginalised and hidden migrant worker health and safety issues from much-needed government attention for decades. Not until the Covid-19 pandemic starkly exposed several fault lines and the social determinants that contributed to widespread inequity.
The pandemic also drew the sidelined ‘industrial health’ (occupational health) dealing with a work-related illness, disease, and disability closer to its much-deserved position as an integral component of public health. The workplace is now increasingly recognised as a key environment to control the airborne spread of an infectious illness that can easily affect large sectors of the community.
As wealthy host countries open borders, governments are taking steps to increase international migrant worker intakes to sectors that depend on their low-paid labour and bolster workforces with critical shortages of low-skilled workers. This should be an opportune time for policymakers and health practitioners to give attention to the injustice, where vulnerable migrant workers who are regularly and unequally exposed to workplace hazards, are primarily seen as a dispensable cheap labour commodity.
Community-based cooperation and culturally sensitive programs can be an effective approach to provide quality services to the most vulnerable migrant workers. Dr Acran Salman-Navarro of the New York University School of Medicine showed how this was done in that city to prevent work-related musculoskeletal disorders that are highly prevalent among migrant workers. Dr Salman-Navarro believes that bringing primary health care and occupational health services together can be applicable in several other industries with vulnerable occupations and contribute to the future of decent work.
Workplace health should no longer remain a ‘blind spot’ in health care systems and needs to be better integrated with public health programs and initiatives. As Dr Hargreaves noted, “COVID-19 is a wakeup call that says inclusive approaches to public health such as vaccine programs are crucial and that tackling the health needs of international migrant workers is an urgent public health priority.”
Migrant workers generally do not have the organised bargaining power of trade unions nor the lobbying capability for political impact. But they are an increasingly crucial sector of the workforce and economy in many countries, where their health, safety and well-being with decent, dignifying and safe work conditions have for far too long been ignored and overlooked.
Note: Mahinda Seneviratne is an occupational health professional in Sydney, Australia. He chairs ICOH’s scientific committee addressing the occupational health of informal workers. Contact: mahindas@hotmail.com [IDN-InDepthNews — 06 March 2022]
Image: Migrant farmworkers in the Italian region of Calabria | Credit: ANSA/Quotidiano Del Sud
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