Migrant Workers’ Right to Health: A Global Advocacy Agenda

Recent headlines describing the plight of thousands of migrants drowning at sea as they tried to make their way from Africa to Europe, are but the most recent reminders of the treacherous journey many encounter in their search for work. Yet, these and other dangers are only part of the story.

The health of migrant workers who eventually manage to find employment abroad is under-prioritized and under-protected in many countries around the world. It is natural to focus on acute violations like drownings, fires, and building collapses. But the health rights of workers extend well beyond assuring their safety. The daily, systemic violations - which are not acute and not even recognized as rights violations - need equal attention.

Access to the highest available standard of health, which includes reproductive health (RH) and family planning (FP), has long been recognized as a basic human right and vital to the quality of life of individuals and communities. The international community has developed well-defined body of rights established by United Nations and International Labour Organization treaties and conventions.

Efforts to clarify the roles and responsibilities of corporations with respect to human rights are newer but no less significant developments. Recent standards developed within the UN system including the Guiding Principles on Business and Human Rights and the Women’s Empowerment Principles, as well as private efforts based on existing human rights and labor standards such as the Dhaka Principles for Migration with Dignity, seek to ensure that all businesses recognize their responsibilities to respect human rights, including those of the most vulnerable. With a large number of the estimated 105 million workers leaving their homes to find work in other countries, including in supply chains of international scale,[1] companies have a responsibility to respect these human rights norms and to demonstrate that respect through ongoing due diligence processes. Too often, however, companies fail to recognize the possible human rights violations of workers who cannot access needed health services due to their employment arrangements. Private industry needs to step up, and the human rights community needs to put worker health on its agenda.

A range of health related issues highlight the challenges involved:

Hazardous Labour and Living Conditions

For migrant workers, their livelihood and economic potential is tied to their health status. However, they are seen often as temporary inputs instead of investments. This fuels a business mentality of meeting very minimal health standards. The labour these workers provide is typically “dangerous, difficult, and demanding,”[2] which puts them at an “elevated risk for an enormous range of injuries and illnesses due to the nature of their jobs.”[3] This situation is exacerbated by the living conditions faced by many migrant workers. Male and female migrants also encounter health risks and violence due to the customary co-location of commercial sex venues with temporary and migrant labour camps.

Barriers to accessing care

In many cases, migrant workers lack access to health services simply because health needs are not even considered a part of their employment arrangement. According to the International Organization for Migration (IOM), “this omission is due to the perception that health is something that should be discussed only by health specialists, even though many of the causes and solutions to improve migrants’ health are found in other sectors, such as labour, social protection, immigration and law enforcement, among others.”[4] Language barriers further inhibit access, long working hours, distance to health facilities, and lack of credentials to access public services. Imagine the actual and perceived barriers to health care for an Indian working in Dubai, a Nepali working in South Korea, or a Bangladeshi in Jordan. Low utilization of health services among migrant workers does not reflect low need.

Gender-specific vulnerabilities

Today, nearly 50 percent of international migrants are women, whose primary motivation for migrating is not surprisingly employment.[5] Occupational health standards typically address reproductive health from the perspective of protection: against pregnancy tests, against chemicals that may damage fertility; and against harassment and violence. Protection is no doubt essential, but women workers are also harmed when their RH needs are not acknowledged. For example, the lack of access to sanitary napkins at the workplace can lead to gynecological infections, not to mention lower productivity. Migrant workers, like many displaced populations, are more likely than the general population to encounter sexual contact - both wanted and unwanted - when placed in new surroundings.[6] FP and RH services are critical components of women’s empowerment and their ability to fully participate in the economy – to get a job, stay in a job, and be promoted.

Recommendations

Migrant workers face many inequities. Yet health is a fundamental right – and systemic violations do real harm to workers, communities and companies themselves. It is in the self-interest of business to address worker health rights, as companies that do so have improved productivity and worker-management relations. Just as different governments have varying levels of resources, companies depending on their size and type have different capabilities. However, respecting the right to health is not about workplaces becoming primary care facilities but instead about applying better management and workplace health practices.

For the human rights community, worker health and reproductive rights are inseparable from women’s empowerment, gender equality and labor rights. We would assert that companies that demonstrate care for worker health, not just safety, are more likely to perform better across a range of human rights concerns. The following recommendations for policy makers, business leaders and civil society are intended to advance efforts to protect the right to health of this vulnerable population within the global workforce:

1. Human rights advocates should integrate health, including sexual and reproductive health rights, firmly into their efforts to improve employment standards related to migrant workers.  The human rights community and labor rights organizations in particular can help bring about structural policy changes by advocating for the inclusion of health related provisions in the global policies, incentive structures, and public and private regulatory mechanisms that companies are expected to address. For example, health should be included in migrant worker contracts.  Additionally, medical examinations should be part of pre-departure procedures along with health promotion activities.
2. Policy makers should support legislative and other actions that ensure workplace policies and practices concerning quality health services apply to migrant workers. Regardless of the employment arrangement or contract length, migrant workers’ basic health needs should be addressed. There are many approaches for doing this – improving workplace-based services (which could include hiring a health professional of the same nationality), contracting with NGO service providers, referring to quality public or private health services, and establishing good workplace health policies ensuring worker health rights. Marie Stopes International, for instance, has successfully provided on site services, trained workplace providers, and developed strong referral networks. Business for Social Responsibility’s HERproject uses peer educators at workplaces to increase health knowledge and behavior change. Those who already provide services to migrants may consider partnering with community health entities to bundle a comprehensive package of services that includes health. Many models exist; the will is lacking.
3. Business leaders should step up efforts to make reproductive health and family planning a part of the corporate gender and women’s empowerment agenda. Business leaders have many opportunities to highlight the links between their corporate responsibility to respect human rights and their policies and practices on women’s health issues in the workplace. For example, the annual UN Forum on Business and Human Rights, to name one, provides an important platform to highlight the role of business in respecting health and reproductive health rights and to discuss good practice in this area.

In the end, wherever human rights and women’s empowerment come together, health and reproductive rights needs, in particular for migrant workers who are often most vulnerable to rights abuses, should be on the agenda and a part of the discussion. Doing so is critical in demonstrating that progress can be made. This is equally important in the context of reproductive health, which is often mistakenly viewed as too sensitive a topic for some countries and for business when in fact it has been successfully addressed at workplaces in some of the most culturally conservative places in the world.

Business can help advance health rights for migrants and all workers through their operations – and there’s a strong business case for doing so. Silence on this issue means invisibility and inaction.

---

[1] http://publications.iom.int/bookstore/free/Migration_Initiatives2014_web.pdf

[2] http://publications.iom.int/bookstore/free/Migration_Initiatives2014_web.pdf

[3] http://kff.org/medicaid/report/migrant-and-seasonal-farmworkers-health-insurance-coverage/

[4] http://publications.iom.int/bookstore/free/Migration_Initiatives2014_web.pdf

[5] http://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---migrant/documents/publication/wcms_344703.pdf