Health risks of Bangladeshi migrant workers31 October 2022
Lt Col Nazmul Huda Khan MBBS, MPH, MPhil
T he migrant workers play a vital role in many countries as a result of economic globalisation. Bangladesh has emerged as a major source of migrant workforce and accounted for around 15 million migrant workers since 1976 in about 174 countries worldwide; out of which three-fourth are employed in Middle East countries. It is estimated that about 5,00,000 Bangladeshi workers leave the country for working abroad each year. In spite of their sweats and sufferings, they are sending remittances those keeping our country's reserve moving and contributing more than 12 per cent of our GDP. The amount of remittances only in 2021 was BDT one lac 89 thousand and 367 crore.
It has been demonstrated that, a significant number of Bangladeshi overseas workers face health hazards abroad. These arise from a number of sources including unsafe workplace, unhygienic accommodation, low calorie intake and even mental and psychological trauma from torture and social displacement. They are frequently subjected to dirty, dangerous and degrading working conditions; women migrant workers suffer from a higher level of discrimination, become the most vulnerable victims. As half of the Bangladeshi migrant workers are unskilled, they cannot work in professional positions. They are engaged mainly in jobs that require manual labour with high risks of workplace accidents and injuries.
Migrants who work in construction sites in overcrowded areas full of hot, humid and unhygienic working environment are prone to skin diseases. They tend to suffer from diarrhea, tuberculosis, hepatitis etc. due to overcrowded accommodation and unhygienic sanitation system. Employees in farms are at higher risks of contacting tuberculosis, eye defect and pain in general. Migrants engaged in mining industries have high risks of lung function impairment, musculoskeletal symptoms, hypertension, diabetes and tuberculosis. Food processors and handlers are exposed to worm infestation. Migrant workers are also at risk from occupational medical condition and health problems such as heart and respiratory diseases, diarrhea, vomiting and peptic ulcer, fatigue, depression, anxiety, stress and medical condition, i.e., diabetes, hypertension, asthma and allergic diseases.
In many countries, Bangladeshi migrants experience social stigma, discrimination and xenophobia which accelerate health risks. Language is a major obstacle to communication with medical professionals for them. Majority of the Bangladeshi women have been victims of sexual or physical abuse and were infected with sexually transmitted diseases, HIV/AIDS, unwanted pregnancy and unsafe abortion and ultimately suffered from trauma. They bear the risks of psychological disorder, depression and schizophrenia; even having history of suicide. Male migrants are also exposed to risks of contracting HIV/AIDS due to unsafe sexual behavior, long-time separation from family, isolation from familiar social norms and values, feeling of loneliness, poverty, exploitative working conditions and sexual abuse.
In many cases, Bangladeshi migrant workers do not have access to health insurance facilities in destination countries. Irregular migration through trafficking is more vulnerable in case of health. Trafficking and irregular movements include long dangerous journeys and result in life-threatening physical and mental problems, even death.
Undocumented migrants avoid using health services out of fear of being penalised, lack of legal entitlements or discriminatory attitudes. Workers are reluctant to use health services as they are paid by the hour or piece of work and they do not wish to seek treatment and miss working hours and a decline in income. They have no choice when serious injuries or illnesses became unbearable. In some cases, mobility also makes treatment difficult for undocumented migrants.
Host countries include a group of medical test centers those conduct tests for potential migrants. The test centers tend to manipulate test results and change results both from 'unfit' to 'fit' and from 'fit' to 'unfit', and extort money from migrants provide favorable reports. Many a times, number of migrant workers return or are sent back to Bangladesh because of health hazards, accidents, injuries, disease or due to 'lack of fitness' although they were certified as 'fit' in the medical tests from Bangladesh.
The health issues of migrant workers during pre-departure orientations in Bangladesh are narrowly addressed. They receive a short briefing, but health issues are not included. Most of the migrants from Bangladesh do not receive any information regarding health provisions in the employment contracts.
Migrants who move through irregular ways, i.e., without passport and visa and travel over land or sea to enter another country illegally face severe health risks including hunger, physical and mental problems and even death in transition.
Every year Bangladeshi migrant workers go abroad to make their dreams into reality; but many return in coffins and dead body bags. According to the Bureau of Manpower Employment and Training (BMET), Bangladesh received bodies of a total of 3,652 migrant workers in 2021, which is 25 per cent more than that of the previous year. A total of 2,907 dead bodies came home in 2020, according to the statistics of Wage Earners' Welfare Board (WEWB). Highest 1,295 bodies came home from Saudi Arabia, the largest job destination country, followed by 725 from Malaysia, 374 from the United Arab Emirates (UAE), 323 from Kuwait and 100 from Bahrain in 2021. According to Hazrat Shahjalal International Airport desk and different medias, it is revealed that as many as 2,315 dead bodies came in the year 2009; 2,299 in 2010; 2,235 in 2011; 2,383 in 2012; 2,542 in 2013; 2,872 in 2014; 2,831 in 2015; 2,985 in 2016; 2,919 in 2017; and 3,057 dead bodies in the year 2018. In many instances, dead bodies remain unidentified because of their irregular job status. Heart attack and stroke mostly cause migrant workers' death as per the accompanying documents while other reasons include road accident, suicide, murder, various non-communicable and communicable diseases.
Number of international organisations and frameworks are pursuing to uplift the migrant's health such as World Health Organisation, The World Health Assembly Resolution on Migrants Health, International Convention of Protection of Rights of All Migrant Workers and their Families, The International Covenant on Civil and Political Rights, Universal Declaration of Human Rights etc. World Health Organisation put due importance for attainable standard of health of migrant workers. The ILO is leading to protect immigrant worker's health and focuses on creating fair labour practices in host countries. International Convention of Protection of Rights of All Migrant Workers ensures right to health care and treatment of migrant. The Committee of Economic, Social and Cultural Rights has persuaded for equal access to healthcare for all persons including illegal immigrants. So, receiving countries of the migrant workers should comply the respective labour laws. Employers are responsible for providing preventive orientation and safety equipment to the workers. It should be their duty to ensure periodic health test and primary treatment of the workers. The employment contract of receiving countries should have provisions regarding health insurance, free medical facilities, occupational and social safety including compensation for injury and death.
To resolve migrant health problems, Bangladesh has formulated various Policies, laws and frameworks i.e., 7th Five-Year Plan (FY 2016-2020), National Strategic Action Plan on Migration Health for 2015-2018, Overseas Employment and Migrants Act 2013, Expatriate Welfare and Overseas Employment Policy 2016, Health Check-up Policy for Potential Migrant Workers 2008 etc. The 7th Five-Year Plan (FY 2016-2020) proposed several steps in alignment with the World Health Assembly Resolution. A three-year National Strategic Action Plan on Migration Health has been developed with the support of IOM. Overseas Employment and Migrants Act 2013 of our country includes a compensation amount in the event of death and injury. The Expatriate Welfare and Overseas Employment Policy 2016 aims at the objective of safe and dignified migration. The Ministry of Health and Family Welfare has formulated policy for standard health test, health insurance, social safety net and maintenance of health profile for potential and returnee migrants as well as their families.
The health issue of Bangladeshi migrant workers mentioned in the Expatriate Welfare and Overseas Employment Policy 2016 should be addressed effectively. An autonomous health department may be established to regulate health care and treatment services for the migrant workers regardless of their migration status at pre-departure, post-arrival and post-return stages of migration. The agencies should explore the prospect of establishing partnerships with health care providing institutions in the host countries. The role of NGOs to improve worker rights is another useful tool in this regard. Social media and investigative reporting can play a role in calling attention to abusive immigrant working conditions and to improvement in workplace conditions.
The role of migrant workers is worthwhile for the countries of origin and the host countries in the present context of global migration. Despite the social and economic advantages of migration, immigrant workers are at risk for multiple health disparities related to their occupation, their legal status, immigration policies and cultural or linguistic barriers. Attention to reduce these disparities can help ensure the success of the global economy and its healthy workforce.
(The writer, former Assistant Director, Kurmitola General Hospital, is public health specialist and PhD researcher).