Health of Migrant worker and occupational hazard

The number of international migrants is on a continuous rise, however: from 2010 to 2015, the total number rose from 220 million to 248 million, corresponding to an average increase of 2.4% per year.
Every year an estimated 105 million people travel abroad to work
This slide shows the distribution of migrants in the world. Europe hosted the largest number of international migrants (82 million), followed by Northern America (59 million) and Northern Africa and Western Asia (49 million). The regional distribution of international migrants is changing, with migrant populations growing faster in Northern Africa and Western Asia and sub-Saharan Africa than in other regions

1. Health of Immigrant Worker Role of Family Physician Prof Dr Faisal Abdullatif Alnasir FPC, FRCGP, MICGP, FFPH, FAM(USA), PhD Honorary faculty, Imperial College, London Chairman; Home Health Care Centre General Secretary; Int. Society for the History of Islamic Medicine Kingdom of Bahrain

2. إ ن صناعة الطب هي "أشرف الصنائع والعلم بها أقدم العلوم" ويجب أن تتقدم في المرتبة على سائر الصنائع والمهن ( في أدب الطبيب ) (اسحق بن علي الرهاوي) (القرن الرابع الهجري) The industry of medicine is: “the most honorable profession, which is one of the oldest sciences and it must rank first to other trades and professions”. Ishaq Ali Alrahawi 4 th Century H Prof Faisal Alnaser 2019 2

3. Prof Faisal Alnaser 2019 3 Healthcare System 

4. Prof Faisal Alnaser 2019 4 Wellness 8 dimensions of wellness: Is being in good physical and mental health

5. Prof Faisal Alnaser 2019 5 Community A group of people living in the same place or having a particular characteristic in common Is a major field of study within the medical and clinical sciences which focuses on the maintenance, protection, and improvement of the health status of population groups and communities Community health

6. Content: Percentage of migrants worldwide The situation in ME and Gulf Factors affecting the health Health risks Effective measures Role of Family Physicians Prof Faisal Alnaser 2019 6

7. Prof Faisal Alnaser 2019 7 Expatriate : a person living outside their native country (professionals, skilled workers, or artists) either independently or sent abroad by their employers,  Migrant : someone who changes his or her country of usual residence, irrespective of the reason in order to find work or better living conditions (moving from one country to another legally).    Immigrant: a person who comes to live permanently in a foreign country.

8. 3% of the global population move outside their country of birth, often for economic reasons. Prof Faisal Alnaser 2019 8 Stilwell et al 2004

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10. Prof Faisal Alnaser 2019 10 The number of international migrants are on continuous rise https://www.ined.fr/en/everything_about_population/demographic However, from 2010 to 2015, the total number rose from 220 million to 248 million, corresponding to an average increase of 2.4% per year. WORLD MIGRATION REPORT IOM, 2018

11. Every year 105 million people travel to work Prof Faisal Alnaser 2019 11 United Nation for Human Rights

12. More than 10 million Filipinos have left abroad seeking jobs. Prof Faisal Alnaser 2019 12 http://www.asianews.it/news-en/Christian-Filipino-migrants Every day, about 3,000 leave the country. Majority go to Arab countries (200,000 in KSA alone).

13. Pratik et al 2011 Prof Faisal Alnaser 2019 13 Migration of Nepalese Worker in 2000

14. Prof Faisal Alnaser 2019 14 Pratik et all 2011

15. Prof Faisal Alnaser 2019 15 Of all the international migrants in 2017: 106 million were born in Asia 61 million in Europe 38 million in Latin America & Caribbean 36 million in Africa Refugees, accounted for 10% (25.9 million). Most (82.5%) live in developing countries (in 2016).

16. Prof Faisal Alnaser 2019 16 One-third of all international migrants originate from 10 countries (in 2019): India 17.5 million living abroad Mexico the second largest (11.8 million) China (10.7 million) Russian Federation (10.5 million) and the Syrian Arab Republic (8.2 million) https://sdg.iisd.org/news/un-desa-takes-stock-of-global-migration

17. Prof Faisal Alnaser 2019 17 https://sdg.iisd.org/news/un-desa-takes-stock-of-global-migration Approximately one-third of all migrants live in only seven developed countries. GCIM. 2005

18. http://www.dailykos.com/story/2011/ Prof Faisal Alnaser 2019 18

19. http://www.dailykos.com/story/2011 Prof Faisal Alnaser 2019 19

20. Prof Faisal Alnaser 2019 20 Age distribution of the migrants https://sdg.iisd.org/news/un-desa-takes-stock-of-global-migration

21. Women: Half of the total population of international migrants worldwide are women. Prof Faisal Alnaser 2019 21 www.ilo.org/migrant 83% of all domestic workers (53 million) in the world are women.

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23. Prof Faisal Alnaser 2019 23 GCC population are > 54 million people staying over 1 million sq miles (Total Land area of the globe : 57.506 million sq mile). World population review,2019 The total GDP of GCC nations is $3.464 trillion.

24. Prof Faisal Alnaser 2019 24 GCC Population

25. Prof Faisal Alnaser 2019 25 >25 million foreign workers in GCC GLMM April 2016

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30. Prof Faisal Alnaser 2019 30 https://www.globalmediainsight.com/blog/uae-population-statistics/2019

31. Prof Faisal Alnaser 2019 31 https://www.globalmediainsight.com/blog/uae-population-statistics/

32. Prof Faisal Alnaser 2019 32 In Burj Khalifa in Dubai: 12,000 laborers worked on the tower https://fanack.com/migrant-labour/the-plight-of-migrant-workers-in-the-gulf-states/

33. Prof Faisal Alnaser 2019 33 90,000,000,000 US$/Year Remittance World Bank, IMF, Arab Monetary Fund 2013

34. Prof Faisal Alnaser 2019 34 Migrants and outward remittances in GCC countries, 2013 Saudi Arabia the second highest remittance sending country in the world in 2006, with a remittances of $34.5 billion. Kuwait, Oman, & Bahrain are ranked in the top 30 sender countries. Bahrain ranks first among remittance sender GCC countries, with remittances equal to 7.8% of its GDP.

35. Prof Faisal Alnaser 2019 35 Middle East Institute, 2010

36. Prof Faisal Alnaser 2019 36 Problems Migrant workers face greater health risks than non-migrant workers Faisal Alnaser, 2015

37. Are perceived as exploitable, cheap and flexible labor, underpaid, without workplace safety and health protections. ILO,2009 Prof Faisal Alnaser 2019 37 Host countries often employ them in 3-D jobs - : Dirty, Dangerous and Degrading

38. Prof Faisal Alnaser 2019 38 Are seen as a burden on society, when in fact their contribution to their host economy is often underestimated. Kawon et al 2011

39. - Attitude Immigrants may not follow preventive care and treatment regimens. Dastjerdi M,20 12 Prof Faisal Alnaser 2019 39 - Cultural differences in health care seeking patterns and the differences in the perception of health care services. Culture shapes an individual's perception of health, illness, and compliance with diagnosis and treatment regimens. National Institute of Health,2002 - Fear of disclosure. Not comfortable talking about their issues out of fear of being expelled from employment. So they tend to tolerate harsh working and living conditions longer than others. Dastjerdi M,2012 Why do they face serious health problems?:

40. Prof Faisal Alnaser 2019 40 Migrants workers can face serious health problems due to: - Adjusting: Migrant workers face difficulties in adjusting to their new society including adopting safe and healthy lifestyles. Faisal Alnaser, 2015

41. Prof Faisal Alnaser 2019 41 Migrants workers can face serious health problems due to: - Coming from developing countries with poor health systems where communicable diseases are not adequately addressed - lack access to local health systems. BSR – Migration Linkages 2012 - Employed in industries that involve dangerous, dirty, and degrading work

42. Prof Faisal Alnaser 2019 42 Migrants workers can face serious health problems due to : - Lack of knowledge of the system - Exposition to higher risk hazards that put them in situation of vulnerability. Cote D 2013

43. Prof Faisal Alnaser 2019 43 Migrants workers can face serious health problems due to: discrimination language and cultural barriers their legal position their low socio-economic status. WHO 2003

44. Prof Faisal Alnaser 2019 44 Migrants workers can face serious health problems due to: health issues impacting them are complex and numerous. could have diseases that are related to their nationalities. e.g. in the UAE level of obesity is high among certain nationalities of migrant workers while the presence of hepatitis C antibodies was found almost exclusive to others. Newson -Smith MS 2010

45. Prof Faisal Alnaser 2019 45 Health risks of migrant worker

46. Prof Faisal Alnaser 2019 46 Work-related accidents and injury Asian migrant construction workers face higher risk of occupational accidents compared with the general population Al-Arrayed A, Hamza A. 1995

47. The Nepalese government revealed 70 nationals had died on building sites in Qatar since the beginning of 2012. Hundreds more are thought to have been injured in falls and accidents with machinery and vehicles. International Trade Union Confederation (ITUC) Prof Faisal Alnaser 2019 47

48. Prof Faisal Alnaser 2019 48 Tuberculosis Cardiac arrests Adhikary , P et al 2011 Injuries: Eye Ear, Burn

49. Prof Faisal Alnaser 2019 49 Headache Anxiety Depression (25.1%) Adhikary , P et al 2011 And high death rates Fatma Al- Maskari , et al 2011

50. Mental Problems: Immigrants from poorer countries are at higher risk of mental illness due to their living and working conditions. Hence there is increase suicidal rate among them. Pratik et al 2011 Prof Faisal Alnaser 2019 50

51. Prof Faisal Alnaser 2019 51 Mental illness Suicide attempts (in UAE 2.5%) Fatma Al- Maskari et al, 2011

52. One of the major risk to health is the Prof Faisal Alnaser 2019 52 Usually they live in a condition that is: Accommodation overcrowded unhealthy Faisal Alnaser, 2015

53. Prof Faisal Alnaser 2019 53 lacks sanitation which could be an environment for deterioration of physical and mental health. Faisal Alnaser, 2015

54. Human Rights Watch: indicated that overcrowded and unhygienic living arrangements of migrants, correlated with spread of disease. (referring to the outbreak of chickenpox in a Sharjah labor camp in 2008). Pernice R, Brook J. 1996 Prof Faisal Alnaser 2019 54

55. Prof Faisal Alnaser 2019 55 Poor nutrition: puts them at great risk of various illnesses Faisal Alnaser, 2015

56. Prof Faisal Alnaser 2019 56 - Abuse : Female migrant workers are at a high risk of physical, sexual and verbal. Arnold F, Shah N,1984; Gurung G, Adhikari J. 2001

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58. Prof Faisal Alnaser 2019 58 How such are overcome

59. It is legal obligation of countries of destination, origin and transit to protect the human rights of migrants on their territory. International Trade Union Confederation (ITUC ) Prof Faisal Alnaser 2019 59

60. When tailoring any interventions to vulnerable populations, we should take into consideration the importance of diverse cultural beliefs and practices Poureslami et al 2011 Prof Faisal Alnaser 2019 60

61. To attain equitable, adequate, and effective access to health care services, migrants need to be educated and informed about the health care system and services it provides. The more they become integrated the more they use health care services effectively. Dastjerdi M,2012 Prof Faisal Alnaser 2019 61

62. A study of lifestyle of Nepalese migrants in UK found that migrants with low levels of education and poor immigration status (e.g. refugee/asylum seeker) are more likely to lack good dental hygiene and regular exercise. Adhikar et al, 2008 Prof Faisal Alnaser 2019 62

63. Countries that are dependent on migrant workers, should review their occupational safety and health (OSH) and make inclusive policy decisions to strengthen these arrangements. Kawon et al 2011 Prof Faisal Alnaser 2019 63

64. ILO Meeting of Experts on Workers' Health Surveillance, in 1997 in Geneva set guidelines for occupational safety and health of workers with the purpose of primary prevention of occupational and work-related diseases and injuries. It were considered to be the basic requirements for the surveillance of workers' health www.ilo.org/safework 1998 Prof Faisal Alnaser 2019 64

65. In The GCC: The Executive Council of Health Ministers recommended screening program for foreign worker to prevent the entry of infected employment. ( It includes epidemiological, psychological, neurological and sexual examinations besides other tests to ensure that these workers do not carry diseases.) www.alraimedia.com/alrai/Article.aspx?id=474801&date=03112013 Prof Faisal Alnaser 2019 65

66. Prof Faisal Alnaser 2019 66 KSA, Bahrain, & the UAE revised their laws to better safeguard rights of migrant workers. Qatar Foundation has drawn up a welfare code to promote quality of life for its migrant workers, & employing migrant welfare specialists. New housing units and hospitals located in industrial areas are currently under preparation. Maria Kristiansen and Aziz Sheikh. Health & Human Rights Journal. July 22, 2014.

67. Prof Faisal Alnaser 2019 67 WONCA Special Interest Group Migrant Care, International Health and Travel Medicine At 2011 WONCA Executive meeting in Cebu, Philippines, expansion of WONCA Special Interest Group (SIG) on Travel Medicine was endorsed. The group will now be known as the SIG on Migrant Care, International Health and Travel Medicine . The vision is for good access and quality of primary care for all displaced people and travelers at all places in the world.

68. Mapping and identifying health risks Building health profiles for migrant workers Developing preventative health programs Ensuring occupational health and safety standards Taking proactive steps to ensure the availability, accessibility, and acceptability of health services in the destination BSR – Migration Linkages 2012 Prof Faisal Alnaser 2019 68 Steps taken to protect the health of migrant workers:

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70. Prof Faisal Alnaser 2019 70 Entrance to Family and Community Medicine 2 months Internal Medicine 5 months Pediatrics 4 months Obstetrics and Gynecology 3 months Surgery in all specialties including Orthopedic Surgery 3 months Ophthalmic Diseases 2 months ENT Diseases 2 months Dermatologic Diseases 2 months Psychiatric Diseases 2 months Emergency Medicine 2 months Radiology and Laboratory (diagnose procedures)                1 month Community Medicine 2 months Family Medicine (continuously in the training center) 9 months Optional programs and selected subjects in primary care 5 months Annual vacations 4 months in total one month for each year Overall training time duration  48 months Arab Board Family Medicine Training program

71. Prof Faisal Alnaser 2019 71 It is our moral obligation to protect people who helped us to change our countries

72. Prof Faisal Alnaser 2019 72 From this

73. Prof Faisal Alnaser 2019 73 To this

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76. Prof Faisal Alnaser 2019 76 Thank You

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78. Source: Migrant workers and health- the role of business Prof Faisal Alnaser 2019 78

79. Prof Faisal Alnaser 2019 79 Enforcement of workers’ rights Public health research and monitoring:  Population-based health profiles should include migrant workers Health promotion programs:  Interventions should address mental health problems, occupational safety, and communicable and non-communicable diseases Accessible, acceptable, and timely health care:  Culturally and linguistically appropriate health care services should be made available. Human rights initiatives:  Mechanisms should be developed to protect against discrimination, Monitoring of progress and increased accountability:  develop the means to assess, describe, and report progress in tackling health inequalities. Key steps to be taken by the GCC countries are: Maria Kristiansen and Aziz Sheikh. Health & Human Rights Journal. July 22, 2014.