Maria Kristiansen and Aziz Sheikh

Published July 22, 2014

As Gulf Cooperation Council (GCC) countries increase global engagement and aspire to host high-profile international events such as the 2022 FIFA World Cup in Qatar and the 2020 World Expo in the United Arab Emirates (UAE), the plight of migrant workers in the region is receiving intensified media attention.1 Here, we describe the long-standing health-related problems these migrants face; reflect on recent positive developments; and suggest ways to improve the health and well-being of migrant workers in this region, as it increases in financial and geopolitical importance.

Oil, infrastructure development, and immigration

Over the past 50 years, the discovery of oil has catalyzed considerable infrastructure development in the six GCC countries of Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the UAE. The consequent need for expansion in the workforce has led to an influx of migrant workers over the past three decades.2 For example, in the 1960s, Qatar had a small, homogenous Arab population of 100,000.This population has increased more than twentyfold to over 2 million, primarily through immigration.3 “Foreigners” now make up 70% of Qatar’s population and an estimated 94% of its workforce. In neighboring Saudi Arabia, migrant workers constitute around one-third of the population.4 Similarly, migrants make up more than half the population in Bahrain.5 In the UAE, migrants account for more than 80% of the population.6 This immigration has helped GCC countries accelerate development, and the resulting remittance flows have undoubtedly had a positive effect on the economic prosperity of certain economically developing regions, including  parts of India, Nepal, and the Philippines. But there is growing national and international appreciation that the basic human rights of these low-income migrant workers are not adequately respected.7

Types of migrants and their exposure to health risks

Migrant workers in the GCC come from a range of countries. A very small minority hails from North America, Western Europe, and other economically developed regions; these workers typically spend relatively short periods of time in well-rewarded professional positions with few health risks, decent housing, and comprehensive health insurance. This is in contrast to the experiences of the overwhelming majority:  unskilled low-income workerspredominantly malefrom Bangladesh, India, Indonesia, Pakistan, the Philippines, and Sri Lanka.8 These migrants tend to be employed as construction workers, domestic helpers, cleaners, and drivers  jobs characterized by low payment, long working hours, and at times, physically and mentally hazardous working conditions.9 Furthermore, many of these migrants experience poor housing conditions and have limited access to quality health care. These factors result in a number of adverse health outcomes, including high rates of work-related accidents and mental health problems.10 Gross human rights violations, including human trafficking, mental abuse, and sexual and other physical violence sometimes compound these health risks.11

Voicing concern about migrants’ living conditions and health status in the GCC

In recent years, the challenges brought about by a large influx of migrants have been addressed by protecting the rights of nationals, for example, through sponsorship laws, mandatory migrant health screenings upon arrival, and restrictions on settlement of migrants.12 Little attention has been paid to the perspectives of migrant workers who, in part because of poverty, unemployment, and in some circumstances lack of safety in their home countries, have been less able to voice their needs. Although critique by key international organizations is necessary to fill this silence, it would run the risk of being dismissed by some GCC audiences as insensitive to the situation faced by the region where reliance on migrant workers is seen as a temporary phenomenon. The voices of reform therefore ideally need to emanate from within the region and be framed within the widely accepted notions of justice and dignity for all sectors of society that are both ingrained in human rights and the long-held religious values of the region.

Some encouraging recent developments

After decades of neglect of this issue, there have recently been a number of small, but nonetheless welcome developments in the region. At the policy level, there has been increased commitment to human rights declarations and the Cairo Declaration on Human Rights in Islam. Furthermore, somefor example, Saudi Arabia, Bahrain, and the UAEhave begun revising laws to better safeguard the rights of migrant workers. Revisions include outlawing employer confiscation of worker passports; allowing transfer of sponsorships; and banning recruitment fees and withholding of wages. Critics, however, have expressed concern about the lack of enforcement of these laws.7 In Qatar, the influential Qatar Foundation has drawn up a welfare code to promote quality of life for its migrant workers, and is employing migrant welfare specialists.New housing units and hospitals located in industrial areas are currently under preparation. These encouraging initial steps hold the potentialif actively supported and built uponto catalyze regional reform.

Where do we go from here?

There is still a long way to go to eradicate health inequalities and ensure the much-needed improvements in living conditions for migrant workers in GCC countries. These changes must target immediate health risks as well as the root causes of these inequalities. Some key next steps include:

  • Enforcement of workers’ rights: Increased bilateral collaboration between GCC countries and workers’ countries of origin is needed to protect against exploitation prior to emigration and to enforce internationally recognized standards and national policies outlining labor rights.
  • Public health research and monitoring: Population-based health profiles should include migrant workers (they are at present typically excluded) and provide detailed information needed for adequate stratification of data on burden of disease, living circumstances, and access to health care services according to ethnicity, sex, and occupation.13
  • Health promotion programs: Interventions should be provided by states and need to address mental health problems, occupational safety, and the most prevalent communicable and non-communicable diseases among different subgroups of migrants.
  • Accessible, acceptable, and timely health care: Culturally and linguistically appropriate health care services should be made available for low-income migrants.
  • Human rights initiatives: Mechanisms should be developed to protect against discrimination, to overcome lack of citizenship for long-term migrants and/or their offspring, and to enable family reunification.
  • Monitoring of progress and increased accountability: GCC countries must develop the means to assess, describe, and report progress in tackling health inequalities, thereby providing a means to monitor the impact of any policy initiatives undertaken.

Conclusions

The Gulf region has emerged as one of the world’s most ethnically diverse regions, but it is also one of the most unequal.14 The number of migrants is expected to grow in the coming decades, and facing up to this challenge remains critical not only for health care policy and practice, but for the wider range of public and private sectors influencing the living circumstances of migrants. While rapid progress is being made on engineering and technical fronts, there is an urgent need for similar progress to be made to reduce health inequalities and fulfill the health rights of the region’s migrant workers.


Maria Kristiansen, MSc, PhD, is Associate Professor of Public Health at the Health Sciences Department, College of Arts & Sciences at Qatar University, Doha, Qatar.

Aziz Sheikh, MD, is Professor of Primary Care Research and Development at the Centre For Population Health Sciences at the University of Edinburgh, Edinburgh, UK; Harkness Fellow in Health Care Policy and Practice at the Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA; and visiting Professor of Medicine, Harvard Medical School, Boston, MA, USA.

Please address correspondence to the authors c/o Maria Kristiansen, Health Sciences Department, College of Arts and Sciences, Qatar University, P.O. Box 2713, Doha, Qatar. Email maria.kristiansen@qu.edu.qa.

Conflict of interest: None declared.

Aziz Sheikh is supported by The Commonwealth Fund, a private, independent foundation based in New York City. The views presented here are those of the author and not necessarily those of The Commonwealth Fund, its directors, officers, or staff.


 

References

  1. Amnesty International, The dark side of migration. Spotlight on Qatar’s construction sector ahead of the World Cup (London: Amnesty International, 2013). Available at http://www.amnesty.org/en/library/asset/MDE22/010/2013/en/ca15040d-290e-4292-8616-d7f845beed7e/mde220102013en.pdf.
  2. P. Naithani, “Challenges faced by expatriate workers in Gulf Cooperation Council Countries,” International Journal of Business and Management 5 (2010), pp. 98-103.
  3. Qatar Statistics Authority, Population structure (May 2014). Available at http://www.qsa.gov.qa/eng/PopulationStructure.htm.
  4. The Economist, “Saudi Arabia and its labourers. Go home, but who will replace you?” (November 2013). Available at http://www.economist.com/news/middle-east-and-africa/21589871-saudi-edict-limit-reliance-foreign-workers-fraught.
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  8. P. Fargues and N. Shah, “Socioeconomic impact of GCC migration” (Cambridge: Gulf Research Centre, 2012). Available at http://grm.grc.net/index.php?pgid=Njk=&wid=Mjc.
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  11. C. Joffres et al., “Sexual slavery without borders: trafficking for commercial sexual exploitation in India,” International Journal for Equity in Health 7/22 (2008).
  12. R. Jureidini, Migrant Workers and Xenophobia in the Middle East (Geneva: United Nations Research Institute for Social Development 2003). Available at http://www.unrisd.org/80256B3C005BCCF9/(httpAuxPages)/
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  14. H. Rashad, “Health equity in the Arab world: the future we want,” Lancet 383/9914 (2014), pp. 25-31.
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