The six Gulf Cooperation Council (GCC) monarchies—Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates—are home to one of the densest global migrant populations. Recent estimates suggest that the collective population of the six states is roughly 56 million, out of which approximately 29 million are non-nationals. In all of these states, temporary economic migrants make up a large component of the population, and in several migrants vastly outnumber citizens. In the midst of the global COVID-19 pandemic, and with confirmation that the virus is spreading across the Persian Gulf, providing targeted policies that address the needs of the migrant community are essential. None of the Gulf states will be able to limit the spread of this disease, nor mitigate its impact on everyday economic and social life, without incorporating the migrant population into its pandemic-control strategies.
Migrant workers in the Gulf contend with a host of underlying health vulnerabilities that, at least partially, arise out of their low socio-economic status and limited social capital. In the context of a national health emergency, these existing constraints not only intensify individual migrants’ potential risk of exposure to disease, they also constrain policymakers’ efforts to mitigate the spread of contagion. The primary issues that have been linked to migrants’ deterioration of health are poor living conditions, limited financial resources, dangerous and difficult work conditions, lifestyle and diet behaviors, lack of access to adequate healthcare, and social marginalization. Lower-income migrants tend to be overrepresented in sectors that are more hazardous and more physically taxing, such as the construction sector and industrial production. Many also work in the service sectors in jobs that require frequent and sustained proximity to others.
Migrant workers also live in low-cost, high density shared accommodation, where disease transmission becomes far more likely. Migrant labor camps and housing units in the Gulf, frequently provided by employers, have received severe criticism by international advocacy groups for the poor standards of living they offer. Overcrowding of both personal spaces and communal areas, limited and ill-equipped kitchen and laundry facilities, and an inadequate number of bathrooms and showers are all factors that make it difficult to ensure basic food, hygiene and sanitary needs for the residents. These existing issues are certainly placing an added strain on the Gulf states’ capacity to enforce measures they have taken to contain COVID-19—such as social distancing and hand hygiene—among the vast migrant worker population. The importance of addressing the particular challenges of migrant workers’ accommodation is something that all the Gulf states are currently keenly aware of. One need only look to the example of Singapore, which did an excellent job at managing its first wave of infections but subsequently suffered a second wave. Singapore was unable to adequately address the particular vulnerability to exposure of its large migrant worker population, who typically live in congested group housing similar to workers’ accommodations in the GCC. Singapore’s rapid second wave of COVID-19 has spread largely among, and through, this migrant population.
Existing studies on the impact of health emergencies on migrant populations indicate additional factors for why lower-income migrant workers tend to be ill-prepared to cope with a pandemic. Lower-income migrants are hampered by generally lower levels of education, lack of literacy and language skills, cultural and social sensitivities around discussing and addressing health issues, inadequate access to timely and accurate information on health rights, and spotty and at best uneven access to healthcare resources in the host state. These underlying constraints affect migrants’ ability to address their health during the normal course of things and create new exposures for them in the midst of cross-society critical health emergencies, such as the one being currently experienced.
Transnational visa processes around the world seek to scrutinize potential labor migrants for disease and filter out those who pose a health risk to receiving states. Even before departing their home states, migrants to the Gulf fall under strict regimes of medical inspection that follow the “exclude before arrival” approach to managing migration and public health. In their countries of origin, all migrants are required to undergo compulsory health screenings prior to obtaining their work-contracts and visas. Migrants engaged in this process experience heightened anxiety, as failing to clear the medical test denies them the opportunity of a much-desired job overseas. Through their encounters with medical authorities at the early stages of the migration process, migrants begin to equate their desirability as workers with their health status. In this highly competitive vetting process, only “healthy” migrants are able to access jobs in the region. This leads to the assumption among migrants that only “healthy” workers will retain their jobs, and creates an enduring sense of precariousness that stays with them once they arrive in the receiving states.
Reinforcing their fears are the compulsory periodic medical examinations that migrants are put through while in the Gulf. While these medical checks are primarily designed as a public health measure, and are designed to detect the early presence of infectious disease in order to prevent community-scale outbreaks, they serve to emphasize migrants’ underlying anxieties. Migrant workers align testing positive with the loss of their Gulf-based job contract and deportation. Given that most lower-income migrants have taken on debt burdens and made personal and familial sacrifices in order to obtain a job overseas, they are understandably reluctant to actively report any symptoms of ill-health and disease. Even if job loss and deportation are unlikely, migrants frequently lose out on paid sick leave if they are unable to work. Lower-income migrants who cannot easily absorb even a few days loss of wages, feel obligated to work despite feeling unwell and may hide indications of illness from their employers and supervisors. These underlying fears around admitting ill-health, to their employers and supervisors, and reluctance to engage with medical authorities can pose challenges both to supporting migrant workers health adequately and also affect states’ efforts to encourage migrants to come forward if they are experiencing COVID-19 symptoms.
In addition to the stress of risking losing out on a job in the Gulf through failing medical screening, migrants struggle with the personal fear of social stigma that is associated with testing positive for certain communicable diseases. The most common infectious diseases that South Asian migrants in the Gulf are routinely screened for are TB and HIV. Testing positive for either of these illnesses can result in social shame and a loss of reputation for migrants from particular cultural contexts. The loss of reputation can have significant economic and social consequences for migrants and their families. The prevalence of testing for these diseases among particular communities of migrants, rather than across the broader community, manifest racialized and class-based biases that are present in infectious disease prevention regimes. Migrant workers are frequently viewed as being the principal carriers and agents for a range of infectious diseases, of having poor hygiene habits, and engaging in social and cultural behaviors that pose risk to broader community health. Lower-income migrants often engage in forms of labor that are considered as “dirty” or “dangerous,” and the nature of their work becomes tied to how others view their physical bodies and hygiene habits. Many migrants also have predisposed health conditions, some as a result of their work conditions, which compromises their health. Both the real degree of heightened risk to illness as well as the stigmatization that migrant workers receive increase during contagious disease outbreaks, when the broader population is fearful, and therefore often tries to find a reason or someone to assign blame to. Public health officials and medical authorities need to anticipate this and swiftly address any potential hostility directed towards migrant groups during the current pandemic. Not only is this essential to prevent social harm for vulnerable populations, but it is also important in terms of ensuring effective means of containing the spread of the virus. Misguided and misinformed campaigns that target certain sub-groups as disease spreaders distract the general population from the fact that viruses, and this current coronavirus in particular, threaten everyone and is spread by anyone.
There has not been a great deal of effort on the part of the GCC host states to mainstream labor migrants’ health needs into national health policy frameworks. Migrant inclusive health policies are essential and also good practice when such a large population of migrants as in the GCC are present. Estimates indicate that there are currently 150 million migrant workers around the world, and many migrants across the globe contend with similar constraints to their health. Despite this, there is no global commitment among states and international bodies that bind them to certain health outcomes for migrants.
Over the past few years, sending countries have taken more proactive steps to formulate practices and policies around the health of migrants. Some of these steps include pre-departure training for migrants to make them aware of healthcare in the host states; compulsory insurance schemes to address disability and death while in a host state; and, measures to help return migrants access adequate health care in their home country. There is a large body of work clearly demonstrating that both at an individual and at the population level, health is impacted by migration. Health status impacts a person’s initial decision-making around migration, and undertaking migration can either positively or negatively affect a migrant’s long term health trajectory. Migration itself does not automatically place all migrants in a position where their health is at risk of deterioration, and there is in fact evidence suggesting that migration can improve health outcomes. It is not necessarily migration that causes poor health outcomes but rather the conditions of vulnerability and exposure that place certain categories of migrants at increased risk. In the absence of a transnational health framework for migrants – one that would bind recruiters, sending states, employers, and receiving states to certain health commitments, and hold them accountable for migrants’ health needs at different stages of the migratory period – it is a challenge to ensure that lower-income migrants’ health needs are met over the long-term.
This lack of national health frameworks for migrants, as well as the absence of a cooperative transnational mechanism for managing migrants’ health, diminishes the capacity for states to rapidly roll out effective policies and initiatives that would specifically target migrant workers in the midst of a pandemic. However, the COVID-19 pandemic and how Gulf states manage it has the potential for creating a more hospitable set of circumstances within the Gulf for lower-income migrant workers’ health outcomes, which in turn could create a more favorable environment for migrant workers in the long term.
Article by Zahra Babar, Associate Director at CIRS
For further reading:
Sana Al- Harahsheh, Feras Al-Meer, Zahra Babar, Maha El-Akoum, Mehran Kamrava, and M. Walid Qoronfleh, “Improving Single Male Laborers’ Health in Qatar,” CIRS/WISH Policy Brief (Doha, Qatar: Center for International and Regional Studies and World Innovation Summit for Health, 2019).
Abdulbari Bener, “Health Status and Working Condition of Migrant Workers: Major Public Health Problems,” The International Journal of Preventative Medicine 8, no. 68 (2017): 1–5.
Ayaz Qureshi, “Structural Violence and the State: HIV and Labour Migration from Pakistan to the Persian Gulf,” Anthropology & Medicine 20, no. 3 (2013): 209–220.
Jason Hickey, Anita J. Gagnon, and Nigoon Jitthai, “Knowledge about Pandemic Influenza Preparedness among Vulnerable Migrants in Thailand,” Health Promotion International 31, no. 1 (2016): 124–132.
Monica Schoch-Spana, Nidhi Bouri, Kunal J. Rambhia, and Ann Norwood, “Stigma, Health Disparities, and the 2009 H1N1 Influenza Pandemic: How to Protect Latino Farmworkers in Future Health Emergencies,” Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science 8, no. 3 (2010): 243–254.
Sarah S. Willen, Jessica Mulligan, and Heide Castañeda, “Take a Stand Commentary: How Can Medical Anthropologists Contribute to Contemporary Conversations on “Illegal” Im/migration and Health?,” Medical Anthropology Quarterly 25, no. 3 (2011): 331–356.