Prof. Dr. Shyam P Lohani

The world has witnessed a constant rise in the population of migrants. Their number is now estimated to have reached around 1,000 million with an international migrant population of 258 million in 2017. Most of the international migrants live in Asia (80 million) followed by Europe (78 million) and North America (58 million), according to the International Migration Report, 2017. Throughout history, there has been migration from rural to urban and from one country to another. The primary reason for those migrations was people’s expectation for better quality of life. The phenomenon of migration and development is interrelated and contributory. Different and unexpected situations in many countries mainly due to conflicts have also caused the influx of migrants to different regions of the world. Migrants have unique health issues. The health issue of Nepali migrant workers who go to the Gulf Cooperation Council (GCC) members and Malaysia is unique and has many dimensions.

Situation
The number of labour migrants from Nepal is ever increasing. According to the Department of Foreign Employment (DOFE), over 3.5 million foreign employment permits have been issued for nine years from 2008/9 to 2016/17 and mostly (over 95 per cent) issued to males. Total remittance influx was Rs. 695.5 billion in 2016/17 which accounted for 23.6 per cent of Gross Domestic Product (GDP) but the growth percentage of remittance was 4.6 per cent as against 7.7 per cent in 2015/16. The number of was expected to grow again slightly to 4.9 per cent in 2017/18 fiscal year (Economic Survey, Ministry of Finance 2017/18).
Out of 3.5 million labour permits issued, around 29.88 per cent were for Malaysia followed by Qatar (21.57 per cent), Saudi Arabia (20.37 per cent) and UAE (10.62 per cent) for male migrants and UAE (24.11 per cent), Malaysia (15.72 per cent) and Kuwait (11.21 per cent) for female (DOFE, 2018). It is obvious that remittance contributes significantly to the country’s economy; furthermore, migrants develop new skills, learn new technologies, and build social and professional relationships that could also benefit the country of origin upon their return.
This data corresponds to almost two deaths every day. According to the same report from DOFE for nine years revealed that the largest number of deaths due to cardiovascular causes were in Qatar (507 deaths) and Malaysia (423 deaths). Other causes of deaths were the natural cause, unidentified cause, and suicide and road traffic accidents. Many reports have indicated that most of the migrant workers from Nepal are under the age of 30 years. Although data is lacking about the age of the deceased, it is speculated that those deaths were mostly among people under the age of 30. The financial consequences of the deaths of those young adults have profound effects on the family, community and the country.
The majority of migrants work in the industrial sectors both manufacturing and construction, agriculture, service industries and domestic work (ILO, 2015). Women mostly engaged in domestic works. Several studies have revealed the migrant workers are engaged in 3-D jobs, dangerous, dirty and demanding which most of the non-migrant workers prefer less. Those jobs are longer in hours with less pay and the working conditions are often poor. Migrant workers are more likely to get exposed to high temperatures, loud noises, and extreme vibrations, fast work speeds and longer hours. At the same time, there have been reports of human rights violations, abuse and workplace violence.
Due to poor occupational safety, migrant workers are particularly vulnerable to poor health outcomes both mental as well as physical, occupational injuries and fatalities. Millions of occupational fatalities have been reported mainly due to poor occupational safety. There are employers in the GCC and other countries and the manpower agencies in the host countries that recruit labourers mainly from low and middle-income countries (LMICs) by luring them with fraudulent and false promises. Those migrant workers, mainly women, end up with abuse, slaved, mistreated and deprived of basic medical and healthcare services. Many of them also become the victim of sexual violence and harassment besides workplace associated injuries.
The limited access to basic health service due to language barrier and change in immigration status, limited coverage, if any, of health insurance at the destination countries, poor working and living conditions, extreme environmental conditions of some of the destination countries, and lack of social and familial support system often have negative consequences on the health of the migrants and further deteriorate their health status both physical and mental. There has been the provision of pre-medical checkup of migrants which screen for both physical fitness and contagious infectious disease but do not screen for mental illness.

Priority
Owing to vulnerabilities of migrant workers and their inherent predisposition to both physical and mental health in their destination countries have a profound impact even after their return to home. There are limited numbers of studies about the health problems of migrant workers from Nepal. Therefore, research studies are needed to prioritise the health needs of the labour migrants as well as age and cause-specific detail data on the morbidity and mortality of the migrants so as to develop appropriate strategies to prevent unnatural deaths in the coming days.
The Government of Nepal has prioritised migration health at its recent national health policy, 2076 with the provisions of pre-medical checkup, a medical check-up at the destination countries and health check-up after their return. It has also provisions of providing preventive health services and increasing their access to curative services at the destination countries and developing migration health information systems. In this context, all stakeholders from the government to manpower agencies to recruiting agencies should come together to effectively implement migration health policies, guidelines and strategies to improve the well-being of migrants both at the destination countries as well as at home.

(Prof. Lohani is the Founder and Academic Director of Nobel College and can be reached at lohanis@gmail.com)