Migrant Health

At least initially, migrants are often in better health than their peers in both sending and receiving countries. This is because good health is an advantage: Admission policies often require migrants to undergo medical screening. For undocumented migrants embarking on demanding and risky journeys, good health is an asset.(111) But migrants can wind up slipping through the health-care cracks-especially those who are undocumented, cannot afford medical care and/or fear deportation. Many migrants are exposed to hazardous working environments, poor housing, labour exploitation and inadequate access to health care.(112)

Migrants–especially those with irregular status–face conditions that can render them more vulnerable to infectious disease and poor health. Indeed, the IOM points to a number of studies that show immigrants have higher rates of infant mortality and congenital malformation. In some countries, first- and second-generation women suffer increased rates of chronic illness.(113) Many women face particular challenges addressing reproductive health-care needs (see Chapter 2). However, health status is determined by various factors, and outcomes are as diverse as the background and overall condition of individual migrants. For still others, moving abroad can offer access to improved health education and services. Nevertheless, educated and skilled migrants are less likely to suffer from the migration experience.

There are several interrelated reasons why certain groups of migrants face increased health risks. First, as WHO notes, poverty is the most critical health determinant of all: The poorest tend to have the poorest health. Compared to residents, migrants are far more likely to be economically disadvantaged.(114)Moreover, most national health-care plans discriminate against temporary and unauthorized migrants by allowing only emergency care for non-citizens. Undocumented migrants also fear that health-care providers will tip off authorities. This often discourages migrants from seeking medical treatment: What often begins as a minor problem can flare up into a serious illness.(115) Despite these and other problems, few decision makers appear willing to revisit existing policies and establish new legislation that would benefit both irregular migrants and the health-care system.(116) Yet receiving countries stand to gain: Migrants who enjoy good health are in a better position to partake of educational opportunities and to contribute more to the national economy.(117) Public concerns over costs should be considered within a broader context: i.e., balancing the greater contribution that healthy migrants can make to their host country against the added costs that accrue to societies that fail to provide timely health care.(118)

MIGRATION AND HIV/AIDS

Migration and HIV/AIDS Despite stereotypes and common assumptions, it is neither migrants nor migration per se that increases the risks of HIV transmission: It is the trying conditions and hardships that many face throughout the migra-tion experience that makes them more vulnerable to infection.(1) Separation from family and spouses, isolation and loneliness, can encourage people to engage in high-risk sexual relations. Mobility itself makes it harder to reach migrants with prevention information, condoms, counselling and testing services or care. Migrant communities are often socially, culturally, economically and linguistically marginalized, which, in turn, throws up barriers to health-care access.(2)The legal status and occupation of an individual migrant will also influence to what degree he or she risks exposure to the virus. Undocumented migrants may fear deportation if they approach health-care providers or may be unable to afford care in the first place. Women migrants who are smuggled; stranded in transit; traveling alone; trafficked; unemployed and left with no recourse but to engage in survival sex or sex work, face heightened risks of exploitation, violence and, by extension, HIV infection.(3) Migrants often know little about HIV and have negligible prior experience with health services in their countries of origin. Seasonal or return migration can also increase the risks of transmission to partners and spouses.(4)

MIGRATION AND HIV/AIDS

So far, researchers have had to tread lightly around the issue of migration and HIV/AIDS owing to a lack of reliable data and the complexity of the issue. Nevertheless, most experts contend that moving from low- to high-risk areas increases the probability of HIV infection and that circular migration boosts chances that the virus will "relocate."(119)

According to a GCIM-commissioned paper, 66 per cent of all heterosexually transmitted HIV infections diagnosed in the EU occur in people from high prevalence countries-particularly from Africa.(120) Similarly, in Australia, more than half of all HIV infections attributed to heterosexual intercourse between 2000 and 2004 were diagnosed in people either from a high-prevalence country or whose partners were from a high-prevalence country. In Canada, one quarter of HIV infections diagnosed in 2005 occurred among people from high-prevalence countries in sub-Saharan Africa and the Caribbean.(121) However, even though migration opponents sometimes blame migrants for being "bearers of HIV/AIDS", it is the migration experience itself that can render them more vulnerable.(122)It also remains unclear at what point in the migration cycle infection occurs: before departure, during transit, in the host country or during a return visit. In addition, migrants are often over-represented in estimates of HIV prevalence because host countries and employers sometimes demand that migrants be tested–something that is not required of residents.

Although there is little data on HIV and migration in poorer parts of the world, migration has been associated with an increased vulnerability to communicable diseases. Philippines Department of Health statistics show that, of the 1,385 Filipino nationals reported as HIV positive in 2005, 33 per cent were overseas workers.(123) In a rural community of Uganda, the seroprevalence rate among returned migrants was found to be 11.5 per cent-twice as high as for those who had not migrated.(124) In South Africa, an estimated 1 in 3 miners, many of whom are immigrants from neighbouring countries, is infected with HIV.(125)

Furthermore, the link between population mobility and HIV constitutes one of the most poorly understood and overlooked factors behind the rapid spread of the disease in Southern Africa.(126)The highest incidence is not in Africa's poorest regions but in countries such as South Africa and Botswana, which boast good transport infrastructure, relatively high levels of economic development and considerable internal and cross-border migration.(127)Data obtained from Mozambique indicate that HIV is spreading fastest in provinces that contain the country's main transport arteries to Malawi, South Africa and Zimbabwe and within the home provinces of migrant labourers working in Mozambique and South Africa.(128) Zambia's highest infection rates are in cities and towns that "straddle major transport routes".(129)

In the 2001 Declaration of Commitment on HIV/AIDS, 189 governments committed themselves to develop and begin implementing, by 2005, strategies that would enable migrants and mobile workers to access HIV/AIDS prevention programmes–including the provision of information and social services.(130) The Commitment calls for the increased representation and participation of diverse mobile populations when it comes to drafting national plans; another recommendation is to involve employers, trade unions, community organizations and commercial sex workers in HIV/AIDS prevention and care programmes.(131) In Thailand, the Government is making an effort to prevent infectious diseases among the many thousands of undocumented migrants detained (often for weeks or months at a time) at the SuanPlu Centre in Bangkok. This includes informing detainees about HIV/AIDS in their own language.(132)

THE HUMAN RIGHTS OF MIGRATE WORKERS

The Human Rights of Migrant Workers Under international law, all migrant workers-regardless of legal status–are entitled to the same human rights protections as any other human being. The International Convention on the Protection of the Rights of All Migrant Workers and Members of their Families is the most comprehensive instrument protecting their rights. Building on other core human rights treaties, the Convention came into force in 2003. It sets out minimum standards that all governments who join the Convention are obligated to uphold. Unlike most human rights instruments, however, this one has not been ratified by most developed countries. For both documented and undocumented migrant workers, the Convention outlines the human rights that all are entitled to enjoy-including protection from enslavement and violence; access to emergency medical care and education for the children of migrant workers; equal treatment as nationals with regard to working conditions; the right to join trade unions and other organizations defending their interests; and rights to cultural identity, freedom of thought and of religion. Documented migrant workers are afforded additional rights, such as access to housing, social and health services, the right to form trade unions and organizations, and to vote in their countries of origin. The responsibilities of migrants to abide by national laws and respect the cultural identity of host country inhabitants are also outlined. Though the right to family reunification is not explicitly recognized, countries are encouraged to facilitate it. The Convention also calls for the elimination of human trafficking and smuggling–clandestine activities so riddled with human rights abuses that they have prompted the adoption of specific Protocols to the 2000 UN Convention Against Transnational Organized Crime. States that are party to the Convention protecting migrant rights are bound to work towards the more humane and equitable management of international migration. Recommended efforts include informing migrants of their rights, providing migrant workers and employers with information on policies and laws, and assisting migrant workers and their families. To prevent abuses, the Convention restricts the recruitment of migrants is to government entities or authorized private agencies. Various other human rights instruments and mechanisms have evolved that aim to further migrant worker rights, including international treaty-monitoring bodies, International Labour Organization Conventions and human rights charters at regional levels. The UN Special Rapporteur on the Human Rights of Migrants has played an important role in bringing attention to the rights of vulnerable groups, especially women and children, and the need for strengthened efforts to prevent abuses, including those that relate to domestic workers, trafficking, violence against women and racism. Migrants can also lodge violations complaints with the Rapporteur.(1)