Lt Col Nazmul Huda Khan : Bangladesh has emerged as a major source of migrant workforce and accounted for around 12 million migrant workers since 1976 in about 174 countries; out of which three-fourth are employed in middle east countries. In spite of their sweats and sufferings, they are sending remittances that keep our country’s reserve moving and contributing more than 12pc of our GDP. The amount of remittances only in 2021 was BDT one lac 89 thousand and 367 crore. These migrant workers are exposed to various kinds of health risks. They are frequently subjected to dirty, dangerous and degrading working conditions; women migrant workers suffer from a higher level of discrimination. 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 and in overcrowded areas in hot, humid and unhygienic working environment are prone to skin diseases. They tend to suffer from diarrhea, tuberculosis, Hepatitis B and C 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. In many countries, Bangladeshi migrants experience social stigma, discrimination and xenophobia which also 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; evenhaving 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 penalized, 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 to 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. World Health Organization put due importance on attainable standard of health of migrant workers. The ILO is working to protect immigrant worker’s health and focuses on creating fair labor 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 included the health issue of migrants in the 7th Five-Year Plan (FY 2016-2020) and proposed several steps in alignment with the World Health Assembly Resolution. With the support of IOM, Bangladesh has developed a three-year National Strategic Action Plan on Migration Health. Overseas Employment and Migrants Act 2013 of Bangladesh includes a compensation amount in the event of death and injury. Bangladesh has promulgated the Expatriate Welfare and Overseas Employment Policy 2016 with 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.
(Lt Col Nazmul Huda Khan, MBBS, MPH, Mphil is a PhD researcher and former Assistant Director, Kurmitola General Hospital).