Through artwork and artist performances an exhibition at Aga Khan University (curated by PHC Global Limited) on December 23, 2021 highlighted that the healthcare needs of over 10 million Pakistani migrants are inadequately appreciated, understood and addressed in Pakistan and the Gulf. This exhibition was part of the dissemination of the findings of SELMA: a multi-country, interdisciplinary study into efforts to protect the health of overseas Pakistani labour migrants.
Pakistan is one of the world’s largest ‘exporters’ of labour, according to the International Labour Organization. Remittances sent by overseas workers to their families in Pakistan during 2019 contributed US$ 21.8 billion to the economy or approximately 8 per cent of Pakistan’s GDP. Data shows that over 96 per cent of Pakistan’s migrants settle in the Gulf Cooperation Council, GCC, which consists of Qatar, Kuwait, Oman, Saudi Arabia, Bahrain and the United Arab Emirates.
The SELMA study saw researchers from University College London, UCL, the Institute of Social and Preventive Medicine, University of Bern. and Aga Khan University’s department of community health sciences conduct policy analyses and stakeholder interviews in Pakistan and the GCC countries to review and assess efforts to protect migrant health and wellbeing in relation to global standards.
Findings from the four-year study showed that structural barriers in migrants’ home and host countries are causing healthcare inequities that are leaving them and their families at risk of poorer health outcomes, both physically and mentally. Researchers described these structural determinants as the conditions in which people are born in, grow, live, work, and age, as well as the economic, commercial, legal, and political structures and institutions that drive these social environments.
For example, since most migrants live in overcrowded accommodation, they are more likely to be exposed to COVID-19. The study cited Singapore’s migrant dormitories as an example of how social conditions can impact health outcomes. They noted that even though migrant workers account for just 5 per cent of the country’s population, they account for 74 per cent of all COVID-19 cases.
The policy analysis component of the study noted that comprehensive global guidelines were present which covered how to promote migrant health through measures such as curbing harmful labour recruitment practices and steps to promote access to public health information. However, SELMA found that even though Pakistan’s policies incorporate nearly half of all policy recommendations on structural interventions, most of these measures were outside of the health sector and 8 out of 10 policies were of low authority, making them difficult to implement.
Even though one-third of Pakistan policies contained equity and one-third contained human rights considerations, none referenced migrants specifically. Few of the policies mentioned gender and did not go beyond recognition of the skewed gender-distribution among migrant populations.
In addition, researchers found that the majority of the policies in Pakistan contained no accountability mechanisms or budgetary commitments to finance measures to protect the health of migrants. The analysis showed that the situation has worsened since the devolution of healthcare matters to the provincial level due to confusion about who is responsible for labour and migration matters.
“Why has the protection of the health of migrants fallen through cracks?” said AKU’s Professor Fauziah Rabbani, one of SELMA’s principal investigators. “Among the reasons is the political framing of labour migrants as a source of economic revenue or replaceable labour. In particular, the sending states like Pakistan are deemed to be in a relatively weaker position to demand enforcement of global guidelines because their economies are so dependent on remittances.”
Speakers said labour migrants from Pakistan make vital contributions to the economic and social fabric of society, most times at severe cost to their own well-being. However, labour migrants continue to be framed as a replaceable economic resource rather than rights-holding participants in society.
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