As the construction boom in the West Asian (Gulf) countries continues, including building of the World Cup related structures in Qatar and the complex of international museums in Abu Dhabi, there is increasing attention and growing concern in the world’s media and human rights organisations about the situation of migrants recruited for low-skilled, low-paid work in these countries. Recent reports estimate that over 90% of the total workforce in some Gulf Cooperation Council (GCC) countries is made up of non-nationals. While most of the migrants in the construction sector, and some in the service sector, are male, there is a continuing influx of female domestic workers in the region. In contrast to workers in high-skilled, high-paid jobs who largely tend to come from richer countries in the global north, the majority of migrants recruited for low-skilled jobs are from South and South East Asia.
The impact of limited employment rights and social protection, including health protection, available to these workers at the lower end of the occupational hierarchy in West Asian countries is much documented. A fundamental underpinning factor is that many of these migrant receiving countries have not ratified or do not conform to international conventions on universal labour and human rights. Alongside other international human rights treaties, Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) provides a clear definition of health as a human right: “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health” encompassing freedom from torture and degrading treatment and from non-consensual or forced medical testing/treatment; and entitlement to adequate conditions (e.g. nutrition, shelter, environment) and access to health information, facilities, goods and services, to prevent disease and to maintain good health.
Even a quick look at recent newspaper and NGO reports and academic articles show how far migrants in low skilled work in West Asian countries are from actually realising health as a human right. The evidence for workers in construction and manufacturing industry ranges from heat exhaustion and dehydration associated with long day time working shifts often involving heavy lifting in extreme temperatures, to workplace injuries that are not sufficiently addressed in terms of both prevention and treatment, and sub-standard insanitary housing conditions. For domestic workers there is evidence of neglected chronic illnesses and poor mental health associated with exploitative work conditions in private households that lie outside the domain of legal enforcement of labour laws.
Largely as a result of intense scrutiny of and pressure by human rights and civil society organisations supporting migrant workers, some Gulf countries are more recently attempting to change the legal system of regulation of migrants in low-skilled work to provide more rights and protection to workers. These include proposals to abolish or fundamentally change the current Kafala system of employment and residence that contractually ties workers to individual or corporate employers (sponsors) in the receiving countries and thus places them in a situation of almost total powerlessness leading sometimes to self-harm and suicide. But the processes of formulation and implementation of policy and employer compliance are slow and complex when there is a seemingly ever-available pool of migrant labour for low-skilled work. In Lebanon very recently under a new directive the security agency responsible for foreigners’ entry and residence has begun to deport Lebanon-born children of migrants and in some cases the mothers themselves, some of whom have lived in the country for many years, to comply with immigration rules that some categories of (low paid) workers are not allowed to sponsor residence of family members. This stark example of a lack of a right to a family life which is associated with most temporary low-skilled labour migration programmes in Asia has fundamental impact on mental health and wellbeing of workers and families in all sorts of ways.
Some practices in countries of origin of migrant workers have their own part to play in creating or reinforcing conditions limiting their health rights. Emerging evidence shows that these include insufficient bilateral agreements between sending and receiving countries regarding health insurance and access to healthcare that is not dependant on the whim of receiving country employers. Practices also include the actions of some recruitment agents in controlling the sexual and reproductive health of women migrating as domestic workers through at times non-consensual and degrading medical testing. In many sending countries local domestic workers themselves are not covered by labour rights laws, as set out in the 2011 Domestic Workers’ Convention and therefore there is little oversight of exploitative and abusive practices of employers in private households that have serious health implications whether the workers become migrants or not.
On the face of it, the Employment Permit System (EPS) in another Asian country that receives large numbers of migrants for low-skilled work, South Korea, provides an alternative method of labour regulation with ‘decent work’ and health rights for migrants equivalent to those of national workers. Since 2004 the South Korean government has set up direct agreements with 15 South and South East Asian country governments for recruitment of migrant workers to fill gaps in low-skilled jobs primarily in construction, manufacturing, fisheries and agriculture thus by-passing potentially exploitative practices of private recruitment agencies. Apart from the application of general conditions of Korean labour laws relating to pay, hours, pensions etc., migrant workers are covered by national health insurance and accident compensation insurance on the same terms as local workers. In 2012 in contrast to the nearly 95% of all outgoing Sri Lankan women migrants who went to GCC countries, Jordan and Lebanon, predominantly as domestic workers, Sri Lankan migrants leaving to work in South Korea were almost overwhelmingly male and for unskilled manual jobs (98%). In fact there is anecdotal evidence that the Sri Lankan government is keen to reduce numbers of female domestic workers migrating to the Gulf countries in favour of increasing male migration to countries like South Korea to ensure a greater consideration of the human rights of workers as part of their labour market conditions. However, reports of international organisations and Korean NGOs document less than optimum health and safety conditions for migrant workers in Korean industrial workplaces, including higher proportions of occupational accidents and more exposure to dangerous substances at work such as lead than among native workers. Migrant workers under the EPS are also not allowed to bring in family members. Such evidence suggests that despite awareness-raising by international organisations such as the ILO and concerted efforts by governments and civil society organisations in both sending and receiving societies, more joint action is needed and there is still a long way to go for migrants in low-skilled work to realise their human rights in health.