Living in an interconnected world makes migration an extremely important global issue. Migration is a process of moving from one homeland to another land searching for jobs, education, and better quality of life. Conflicts, poverty, inequalities, and lack of sustainable livelihood encourage people to leave their homes for a better future for themselves and their families, and also modern transportation helps them to move easily.
About 244 million people are estimated to be international migrants, and even more, are internal migrants (people who move within the same country of birth) in 2015. According to the WHO, 1 billion people (one in seven of the world’s population) are migrants in today’s world, in which about 68 million of them are displaced forcibly. Most international migrants are people moving in the countries of the “global south” (between low- and middle-income countries).
However, this is partly addressed in the policymaker’s and the researcher’s agendas, rather than the irregular migration to the high-income countries. The rapid increase in the people’s movement has a great impact on their health. The issue started many years ago, during the era in which the spread of infectious diseases due to colonization and continues till the spread of contemporary pandemics due to globalization. Although migration is recognized as one determinant of health, policies that address migration mainly conducted from the policy sector such as international aid, trade, immigration enforcement rather than from the health sector which probably has different goals and perspectives.
The Gulf countries (GCC)region is one of the known destinations for migrant workers. In which Qatar, UAE, Kuwait, Saudi Arabia, and Bahrain consider to be the 3rd largest destination for labor migration in the contemporary world after the global north. Migrant workers in those countries account for over 10% of the global migrants.
Over the last 50 years, the exploration of oil has enhanced the development in those countries resulting in a continuous need for a workforce to cover the labor market. A large number of migrants come from India, Pakistan, Nepal, and the Philippines (low to low middle-income countries)(9). Remittance sent by migrants contributes to South Asian countries’ economic prosperity by promoting development at the macro(national) and micro(individual) levels and solving the excess labor supply and youth unemployment problems. South Asian workers are mainly low-skilled workers employed in the construction and domestic sector. They work in jobs characterized by long hours, low payment, and hard conditions. For instance, In the UAE, construction workers stay outdoors in extremely hot temperatures for long hours, however, the UAE laws permit workers to break in the hottest hours.
In Qatar, a survey was conducted to find that 56% of migrant workers do not have a government mandate health card which is vital to access healthcare services. A way to exempt the employer from paying the fees levied by the government on issuing these cards. Also, labor camps witness unhealthy living conditions. Furthermore, migrants are subjected to discrimination and work-related accidents that affect their physical and mental health. Domestic workers who are mainly females are subjected to violence, sexual abuse, psychological stress, and exploitation. Also, families of migrants who are left behind are subjected to social disruption and family weakness which increase the migrant’s psychological stress. Some reports reveal a high rate of psychosis and suicide among low migrant workers in the Gulf countries, but official reliable data is missing. Another hardship migrants face in those countries is the sponsorship system (Kafala). A system that controls the migrant by allocating him to a specific job making his life and fate depends heavily on the employers. Over the last decade, the system has been criticized for human rights violations. Furthermore, migrants face cultural, social, and economic barriers to access health services. Additionally, lack of migrant’s knowledge about their rights and laws hamper access to these services. In a neglected way, addressing these public health risks does not appear to be a priority for the government and employers in GCC countries. Although tens of millions of South Asian workers flow to the Arabian Peninsula, millions of impacted households due to migration make migrants return home.
Possible solutions and recommendations
Although GCC countries began to revise laws to safeguard migrants’ rights after years of neglect, it has been criticized that enforcement of laws is still weak. A reform policy that addresses migrant’s rights would make a great difference especially if GCC countries want to incorporate it in the global community and host international events. Moreover, changing the governmental strict control on outside research about migrants’ rights would minimize reliance on grey literature to address the problem. Research specific to the gulf countries which differ from the western countries is the key element to explore any breach as currently, migrant’s right violation is mainly addressed by a limited number of researches. GCC countries who are high-income countries can work to provide targeted culturally appropriate programs that integrate South Asian migrants within the community, health promotion programs, and use ethnic-specific health indicators to identify South Asian migrants’ needs.
Recently, in May 2019 WHO set a global action plan to promote health focusing on achieving universal health coverage (UHC) including migrants regardless of their status. Whom EMRO framework to achieve UHC also can guide the GCC countries to take more responsibility for the health of their citizens and expatriates. It is believed that campaigns and advocating strategies about migrant’s rights that engage the government and employers are important to raise awareness about the issue. Furthermore, employers in Gulf countries are required to ensure good health coverage for workers and compensate for any work-related injury. Also, regular serious inspection for the migrants living conditions, camps, and workplaces are important to ensure good hygiene and safety. The government in migrant’s countries can work to raise migrant’s awareness about their rights to avoid any exploitation. Public health research specific to gulf countries has to include migrant’s health information such as measuring the burden of the diseases, living conditions, and access to health services in the country population profiling.
The income level of the Gulf countries is comparable to most developed countries, but health care expenditure is still much less and expected to increase in the future. That may enhance the opportunity for these countries to consider migrants’ health as part of their public health strategies. There should be more emphasis on achieving the right to health concept by promoting equal access to preventive, curative, and palliative health services for all. A concept that guarantees availability, accessibility, acceptability, and quality (key component of universal health coverage) core elements to ensure health for all without discrimination. A new approach (a right-based approach grounded in medical ethics) that concerns the migrant vulnerability, occupational and interpersonal hazards, social exclusion, discrimination, and universal access to health care services has to be considered rather than the old public health approach that relies on preventive and screening measures of migrants. However, public health preventive measures are still crucial activities that work to reduce harm and maximize the benefit of migration.