Through artwork and artist performances, an exhibition on gender, displacement, and health held at Aga Khan University (AKU) in Karachi 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 AKU’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.
In summary, researchers noted that two out of three areas: authority, accountability and budget; and equity, gender and rights orientation needed strong attention from Pakistani policymakers, while the third area, comprehensiveness of global guidance recommendations present, needed more attention. Interviews with migrants from Pakistan based in the GCC countries reinforced the study’s key findings.
Pakistani labourers based in the GCC stated that little political attention is paid to the long-term well-being of this marginalised group in either country and that there are very few political demands to do so. Researchers noted that there is little understanding that structural interventions are important to promote the health of labour migrants and that as a result the needed inter-sectoral and inter-governmental coordination machinery is lacking.
Over 272 million people currently live in a country other than that of their birth. Some move in search of better opportunities, for others extreme poverty, insecurity, natural disasters or war have driven them from their homes. Even then, SELMA researchers noted that migration as a determinant of health remains understudied. For example, a recent bibliometric analysis found that only 6 per cent of all papers published on migrant health were focused on labour migration. And a systematic review of structural interventions to address the health of labour migrants found only two published studies.
The physical exhibition also included screenshots from a virtual microsite, selmaprojects.com, launched on December 18 – International Migrants’ Day [declared by the United Nations]. This microsite recreated lived experiences of Pakistani labour migrants from the GCC and refugees and asylum seekers in the United Kingdom via art, stories, audio installations and spoken word performances. Over 100 participants from all walks of life including civil society, NGOs, government agencies, academia, political figures, and human rights activists were in attendance.
Yusuf, a Pakistani taxi driver based in Qatar, said: “If I got injured or ill, the company only gave us a panadol… Some of us got very sick and injured, but no health support was provided.”
Another Pakistani labour migrant said: “Some of us got very sick and injured, without any medical support. We ate food off the streets and went through a difficult time.
The work of the SELMA project is supported by a grant from the Wellcome Trust. The study’s principal investigators are UCL’s Sarah Hawkes and AKU’s Fauziah Rabbani.