Chapter 1 The Good, The Bad, The Promising:
Migration in the 21st Century

A World on the Move

Unequal Opportunities in a Globalizing World

Between a Rock and a Hard Place:Irregular Migration

Forced Migration: Refugees and Asylum-seekers

Harnessing Hope: International Migration, Remittances and Developent

Burden or Boon? Impact on Receiving Countries

Migrant Health

Beyond Difference: Living with Diversity

"Each year, en route to the United States, thousands of migrants like this Honduran boy stow away through Mexico on the tops and sides of freight trains." ©Don Bartletti / Los Angeles Times

Since the very dawn of humanity, people have migrated. Exoduses and migratory flows have always been an integral part, as well as a major determinant, of human history. Yet large intercontinental movements only began in the 16th century, with the expansion of Europe and the settlement of colonies.(1) Over the last two centuries, migration rose to an unprecedented level, primarily owing to the globalization of economic activity and its effect on labour migration.(2) While the great majority of those who move are still internal migrants (individuals or families who migrate within their own country), the number of international migrants(3) is substantial.

A World on the Move

International migration is a vital part of today's globalized existence. It can play a key role in development and poverty reduction. It has clear benefits that could be enhanced and disadvantages that could be minimized. Despite this, many of the issues surrounding migration are complex and sensitive. The introduction of peoples from one culture into another tends to generate suspicion, fear and even downright xenophobia. High profile incidents involving migrants and heated debates have both underscored the stories of "migration gone bad". The millions of stories of "migration gone good" - of women, men and youth who leave their country and contribute to both their adopted and home countries through their skills, labour and taxes–tend to go largely untold.

Recent decades have witnessed a dramatic change in the migration landscape as transport and communications have improved within an increasingly globalized world. All nations are now involved with the movement of people–whether as origin, transit or receiving countries. The number of people counted as living outside their country of birth has almost doubled during the last 50 years–increasing to 191 million in 2005.(4) Women now constitute almost half of all migrants and dominate in migration streams to developed countries (see Chapter 2).

Migration can be voluntary or forced, although the actual experience may contain elements of both. Most people migrate for labour, family reunification or marriage. The demand for labour migrants (i.e., those searching for better economic opportunities abroad) has been a major factor in rising levels of migration to developed countries.(5) It is with respect to this group that experts invoke the potential role of migration in development and poverty reduction–especially given the significant impact that financial remittances and other benefits can have on countries of origin. Forced migration and trafficking, on the other hand, encompass the more poignant vulnerabilities associated with international movements– particularly where it involves women and children (see Chapters 3 and 4).

Despite perceptions to the contrary, the proportion of international migrants worldwide has remained relatively low, growing only from 2.5 per cent of the total global population in 1960 to 2.9 per cent in 2000.(6) Nevertheless, net migration accounts for a growing and major share of population growth in developed regions–three quarters in 2000-2005.(7) While in developing regions, emigration has not led to significant decreases in population growth, in 48 countries–mostly small or island states–it has resulted in reductions of more than 15 per cent.(8)

Today, the number of people living outside their country of birth is larger than at any other time in history. International migrants would now constitute the world's fifth most populous country if they all lived in the same place–after China, India, the United States and Indonesia.(9) Nevertheless, migration has actually slowed: that is, the absolute number of new international migrants has decreased from 41 million between 1975 and 1990 to 36 million between 1990 and 2005.(10)Part of the decline can be attributed to the drop in the number of refugees.

Developing countries are experiencing a sharp reduction in the immigrant growth rate, while in developed countries (excluding the former Soviet Union), growth continues to expand: Of the 36 million who migrated between 1990 and 2005, 33 million wound-up in industrialized countries.(11) These trends reveal that 75 per cent of all international migrants now live in only 28 countries.(12) Between 1990 and 2005, 75 per cent of the increase occurred in only 17 countries, while migration actually decreased in 72 countries.(13) In sum, migration is concentrated in a relatively small number of countries: One out of every four migrants lives in North America and one of every three in Europe.(14)

Figure 1: Status of Ratification of international legal instruments related to international migrataion

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Source: United Nations. 2006. International Migration and Development: Report of the Secretary-General (A/60/871).

Unequal Opportunities in a Globalizing World

Growing interdependence between countries, coupled with widening inequalities, will probably lead to the further intensification of international movements. In the "worldwide scramble for skills",(15) advanced countries are increasingly tapping a larger pool of highly mobile labour.(16) At the same time, if their economies are to continue to grow, developed countries will require more migrants to undertake low-paying work that their native counterparts are unable or unwilling to do–particularly at the low wages and working conditions offered.

These jobs–known as the four Ds: dirty, difficult, demeaning and dangerous(17)–include garbage collection, street cleaning, construction, mining, sex work, etc.(18) Other occupations, which local workers may or may not shun, are seasonal and require a complement of foreign workers.(19) At the other end of the scale, the demand for highly skilled professionals in technological, scientific, managerial or administrative activities is also increasing.(20) Most rich countries are open to, and indeed encourage, immigration at the top end of the skill range but are ambiguous or negative about their needs at the lower range.


Migrants tend to possess certain demographic and socio-economic characteristics in terms of age, sex, education, occupational category or willingness to face risks. These factors differentiate them from the rest of the population in their communities of origin.(21) Two trends stand out: on the receiving side, the demand for labour at both ends of the occupational spectrum (i.e., highly skilled and low-skilled)(22) and, despite the dearth of age-disaggregated data, the fact that a significant proportion of migrants are aged 15 to 30 years.(23) Migrant selectivity, in turn, has a direct impact on who benefits and what those benefits will be, both in origin and destination communities.

It is widely believed that most migrants come from the poorest populations. This is incorrect.(24) In fact, emigrants are usually better educated than those left behind.(25) The vast majority en route to the Organization for Economic Co-operation and Development (OECD) countries, for example, possess a secondary (high school) education or higher.(26) With the exception of short-distance movements across borders (i.e., people migrating from Mexico and Central America to the US, or Turks to Western Europe), migrants generally need access to information and some sort of bankroll (as much as US$60,000 for Chinese migrants(27)) in order to cross borders—whether legally or illegally.


The demand for skilled workers can result in the emigration of a substantial number of skilled workers from source countries. This fact is at the root of one of the major debates surrounding international migration and can represent a significant loss for developing countries. Countries spend considerable resources training highly skilled professionals: When they leave, the sending country loses both emigrant skills as well as its initial investment.

Concern with skills depletion is nothing new, but global competition is driving countries to recruit more highly skilled migrant workers in order to maintain and increase their economic edge. As a result, researchers estimate that between a third and half of the developing world's science and technology personnel now live in the developed world.(28) However, a World Bank study concludes that for "22 of the 33 countries in which educational attainment data can be estimated, less than 10 percent of the best educated (tertiary-educated) population of labour-exporting countries has migrated."(29)

What is a godsend for the developed world, however, can be devastating for more impoverished countries. Perhaps nowhere is the effect of "brain drain" more acutely felt than in the already fragile health systems of developing countries.(30) While sub-Saharan Africa is now staggering under the highest infectious disease burden in the world (25 per cent), it retains only 1.3 per cent of the world’s health-care practitioners (see Figure 3).(31) In some countries, the supply of nurses and doctors has been severely depleted.(32) Aggressive recruitment policies on the part of developed countries seeking to address skills shortages in their own health workforces are partly responsible.(33)

Recent World Health Organization (WHO) surveys show that the intention to migrate is especially high among health workers living in regions hit hardest with HIV/AIDS—68 per cent in Zimbabwe and 26 per cent in Uganda.(34) The Global Commission on International Migration (GCIM) reports that more Malawian doctors are currently practicing in the northern English city of Manchester than in the whole of Malawi. Only 50 out of the 600 doctors trained since independence are still practicing in Zambia.(35)

Although worrying, these types of situations do not tell the whole story. Some researchers argue that in order for the brain drain to be detrimental, two conditions must prevail: the loss of a high proportion of a country's total educated population and adverse economic consequences. Researchers observe that small, less-developed countries, particularly in Africa and in the Caribbean, are most likely to suffer the effects of brain drain.(36) For example, in 2000, over 70 per cent of the highly educated population of Guyana, Haiti, Jamaica and Trinidad and Tobago were living in OECD countries.(37)

Direct and indirect impacts (feedback effects) also need to be separated out in order to judge the overall effect of emigration. Direct economic impacts are likely to be adverse: The loss of human capital and lower levels of education in the remaining population can retard economic growth and stall efforts to reduce poverty. However, several positive indirect impacts have also been identified.(38) Indeed, the World Bank maintains that, despite the fact that developing countries are increasingly concerned about "brain drain", losses may be more than offset by remittances and increased trade and investment.(39) Put more simply, remittance income can spur consumption in the home country and can be used to invest in businesses.

Figure 2: The 20 countries or areas with the highest numbers of international migrants, 2005

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Source: UN Poplation Division. "Trends in Total Migrant Stock: The 2005 Revision"
(POP/DB/IG/Rev.2005/DOC), p.11.


Available research does not lead to a simple conclusion: Benefits can only be determined according to each specific case.(40) Moreover, when highly trained people find no outlet for their profession at home, neither the person nor the country benefits, and the end result may be "brain waste."(41)

Altogether, the idea of "brain drain" tells only part of the story concerning the overall impact of migration on an economy or society. Consequently, the intuitive policy response–to plug the drain–will likely be ineffective. Recent research promotes the idea of "optimal brain drain"–that is, that an increase in the emigration of skilled migrants may actually benefit the source country in some cases.(42) Lessons suggested by an analysis of Taiwan, Province of China (where brain drain was eventually transformed into gain), include: subsidize education only up to the level actually demanded by the national economy; use migration as a "brain reserve" in terms of advice and returning skills; support diaspora networking and recruitment; and build a critical mass of returnees.(43)

There are also practical reasons why attempts to restrict mobility may simply not work. Many migrants will find ways around recruitment bans. Furthermore, policies that have attempted to curb migration have historically met with little success. Efforts to limit mobility from particular countries could also end up inhibiting development. Indeed, those policies most likely to be effective are those that accept existing trends rather than seeking to reverse them.(44) The International Organization for Migration (IOM),(45) the Economic Commission for Latin American and the Caribbean (ECLAC)(46) and the Global Commission all support this view.(47)

Figure 3: Africa's Health-care Crisis

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Source: World Health Organization. 2004. "Addressing Africa's Health Workforce Crisis: An Avenue of Action." Paper prepared for the High-Level Forum on MDG's, Abuja.

Between a Rock and a Hard Place: Irregular Migration

Increasing labour demand and widening disparities between countries encourage would-be migrants to move to wealthier countries in order to improve their prospects. And even though aspiring migrants are often unable to carry out their proposed move legally, they will do so regardless. Many countries are increasingly reluctant to receive large numbers of permanent migrants(48) but widening economic and social disparities could lead to greater numbers of undocumented migrants willing to flout regulations in exchange for the promise of a better life. Experts and development institutions also increasingly point to the "asymmetry" of the globalization process: the fact that goods, capital, services, information and ideas are allowed to flow increasingly freely across international borders, while people are still confronted with a wide range of official controls.(49)

Migrants with irregular or undocumented status(50) are people who do not have the proper visa to enter, stay or work. Because of their uncertain status, they tend to take low-paying, "off-the-books" cash-only jobs. As a result, undocumented migrants are more likely to be exploited, work long hours, suffer poor health and live in substandard and often illegal housing. If female, they are more likely to be sexually and physically abused. Irregular migration can also undermine the host country's labour protections, pension schemes and legal system by providing would-be employers with a cheap and exploitable pool of workers with no recourse to collective bargaining and other means of redress.(51) Because undocumented migrants are not officially registered, their actual number is unknown in most countries. Global estimates vary widely at between 30 and 40 million.(52)

Undocumented migrants confront huge risks while attempting to reach their destination. Every year, newspapers are filled with tales of those who did not make it—migrants who drowned or died of exposure or were murdered by unscrupulous smugglers. Every year, thousands of migrants from Africa try to scale the fence barrier that separates the Spanish enclaves of Melilla and Ceuta from the rest of Morocco.(53) As authorities crack down, desperate migrants are increasingly embarking on even more hazardous crossings. The peril is not confined to Africa and Europe. Thousands of people from all over Latin America and the Caribbean lose their lives attempting to reach the United States or Canada.(54)



International migration both facilitates and constrains the realization of the Millennium Development Goals (MDGs).(1) In his 2005 report, In Larger Freedom, UN Secretary-General Kofi Annan cited migration as “one of the major substantive issues of the day(2), while still others rightly argue that "every MDG has some linkage, direct or indirect, with migration."(3) Many people are increasingly looking to migration as a way to provide for their families. Thus, remittances (migrant earnings that are then sent home) can play directly into MDG Goal 1–eradicate extreme poverty and hunger; Goal 2–universal primary education; and Goals 4, 5 and 6 on health. Remittances, especially when women determine how they will be spent, are often invested in meeting daily needs and improving family nutrition, education and health. Contributions, however, are not limited to financial capital only. Diaspora communities can also encourage development through investments, the establishment of trade links and the transfer of skills, knowledge and technology. Female migrants in particular are more likely to impart what they have learned about the value of education and good health-care practices to their families and communities back home. Cross-border migration is directly relevant to MDG health Goals 4, 5 and 6: improved maternal and child health and combating HIV/AIDS, malaria and other diseases. In several countries of origin, the migration of skilled health-care workers has contributed to devastating shortages in already strapped health systems—including those coping with high HIV, maternal and infant mortality and morbidity rates. Schools are also suffering from the depletion of teachers in some countries. But many migrants also benefit from improved access to education, health information, knowledge and services in their new countries—including in the area of sexual and reproductive health. Family planning empowers women to manage their fertility–something that their counterparts in origin countries are often unable to do. Migration can contribute to Goal 3–promote gender equality and empower women–though it can also place migrant women at risk (see Chapter 2). According to the IOM, gender is "possibly the single most important factor shaping the migration experience", with differing sets of obstacles and/or opportunities for male and female migrants.(4) So far as young people are concerned, most migrate because of a lack of opportunities in their home countries. Thus, migration relates to one of the targets under Goal 8: a strengthened global partnership to increase decent work for youth.

Forced Migration: Refugees and Asylum-seekers

Forced migration is that which results from coercion, violence, compelling political or environmental reasons, or other forms of duress, rather than from a voluntary action.(55) It often puts migrants in considerable jeopardy. Although the population of forced migrants is small in comparison to labour migrants, it is made up of some of the most vulnerable and marginalized groups.

The best-known and most-measured group within the forced migration category is that of "refugees": people who flee countries hit by war, violence, and chaos, and who are unable or unwilling to return to their home countries because they lack effective protection. In 2005, there were 12.7 million refugees: 8.4 million under the responsibility of United Nations High Commissioner for Refugees (UNHCR) and an additional 4.3 million under the charge of the United Nations Relief and Works Agency for Palestine Refugees (UNRWA).(56) Overall, refugees now make up 7 per cent of all migrants(57)–down from 11 per cent in the early 1990s.(58)

Unlike labour migrants, who tend to gravitate towards developed regions, an estimated 90 per cent of all refugees currently live in developing countries.(59) Most refugees seek safe havens in countries bordering their own. During the 1994 Rwanda genocide, for example, more than a million refugees crossed into Goma in only three days while, since 2004, an estimated 730,600 Sudanese refugees have fled to Chad, the Central African Republic, Democratic Republic of the Congo, Ethiopia, Kenya and Uganda.(60) Refugees represent some 18 per cent of international migrants in Africa, 15 per cent in Asia and 3 per cent in Europe.(61)

Asylum-seekers are individuals who apply for recognition of their refugee status in another country or through an embassy, and who usually must wait pending a decision from an appropriate body. In 2005, UNHCR reported that 336,000 people applied for asylum in 50 industrialized nations–mostly in North America and Europe–down by nearly 50 per cent since 2001. Levels were the lowest in nearly 20 years with the biggest decreases in Canada and the US. The precipitous drop is attributed to tightening regulations in receiving countries as well as the resolution of a number of longstanding conflicts.(62) Asylum-seekers are facing increased scrutiny owing to concerns that non-refugee migrants are misusing the asylum system in order to gain regular admission. Some critics charge that legitimate asylum-seekers–many of whom migrate through irregular channels in search of protection—are unfairly paying the price for country efforts to crack down on illegal immigration and smuggling. A number of countries automatically detain individual asylum-seekers pending the decision as to whether they qualify for asylum. If not, they face deportation to their country of origin.

Asylum-seekers can remain in limbo for months or years on end.(63) Asylum-seekers whose applications are rejected often cannot be deported because the country of origin will not take them back, or they lack passports. Because laws frequently bar them from seeking jobs in the formal sector, they often end up labouring in the more insecure and unregulated informal economy.(64)

Figure 4: Remittances to Developing Countries

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Source: World Bank. 2006. Global Econoic Prospects.

Harnessing Hope: International Migration,
Remittances and Development

Remittances–that is, migrant earnings sent back to countries of origin–are the main reason experts point to international migration as important for poverty reduction. Although exact numbers are hard to pin down, the sums are enormous. The World Bank estimates that, in 2005, formally transferred remittances rang in at about US$232 billion –of which developing countries received $167 billion. (65) The actual amount of remittances is considered to be substantially higher, since this figure does not take into account funds transferred through non-formal channels.

Remittances are considerably larger than the value of Official Development Assistance (ODA) and comprise the second-largest source of external funding for developing countries after Foreign Direct Investment (FDI). Furthermore, remittances tend to be a more predictable and stable source of income than either FDI or ODA. For some small countries they represent a high share of GDP, such as in Tonga (31 per cent), the Republic of Moldova (27 per cent), Lesotho (26 per cent) and Haiti (25 per cent).(66)Fully 70 per cent of China's FDI comes from the Chinese diaspora.(67) So great is the impact on developing world economies that the World Bank theorizes that a 10 per cent increase in remittances as a proportion of a country's GDP could result in a 1.2 per cent reduction in the share of people living in extreme poverty.(68)

This is borne out by statistics. In Nicaragua, more than 60 per cent of the 22,000 households who escaped poverty between 1998 and 2001 had a family member living abroad.(69) Remittances sent by migrants to El Salvador, Eritrea, Jamaica, Jordan, Nicaragua and Yemen in 2000 increased the GNP of these countries by more than 10 per cent.(70) That same year, 1.2 million Moroccans managed to escape poverty purely on the strength of remittance income alone.(71) According to ECLAC, in 2002, remittances from abroad helped to boost 2.5 million people living in Latin American and the Caribbean above the poverty line.(72)

The propensity to remit–and the amount sent–depends on a variety of factors such as age, number of dependents, the marital status of the migrant and the duration of residence in the host country. Thus, one study finds that Mexican migrants are most likely to remit when they are married, under the age of 40 and with strong social contacts in the host country.(73) Women send a larger proportion of their lesser resources than men(74)(see Chapter 2); temporary migrants send more money than permanent residents; and unskilled/semi-skilled labourers tend to generate more than highly skilled professionals (although this is partly due to the fact that there is a smaller pool of the latter).(75) Another factor that affects remittance levels is the strength of the migrant's kinship ties and intent to return to the country of origin. In other words, migrants who plan to eventually head back home are more inclined to remit than those who choose to stay. By implication, this also means that remittances may decline as ties with communities of origin weaken over time.(76)

Today, the number of people living outside their country of birth is larger than at any other time in history. International migrants would now constitute the world’s fifth most populous country if they all lived in the same place.

While the impact of remittances on developing countries would appear to be clearly beneficial, part of the literature still questions whether remittances have positive implications for short-term poverty or longer-term development. A major issue is that the poorest people and the poorest countries profit the least from remittances. The largest recipients are middle-income countries: Sub-Saharan Africa received only 1.5 per cent of all remittance flows in 2002.(77) This only serves to show that people from the poorest regions have the most difficulty migrating, earning and remitting funds from abroad. Another concern is that remittances can sometimes exacerbate income inequality in the country of origin, with remittance-receiving families and communities prospering while less fortunate neighbours do without.(78) In addition, some experts argue that remittances encourage dependency by discouraging government efforts to take the steps necessary to restructure their economies.(79) Still others contend that donor countries will use remittances as an excuse to shrug off ODA commitments to combat poverty, while developing countries might neglect the needs of their most vulnerable populations because some poor families are receiving remittance income. Thus, despite its contribution to poverty reduction, migration is not necessarily the ultimate equalizer—particularly in an increasingly unequal world.

Some experts also express concern that most remittances do not generally find their way into productive investments. This is because remittances are privately owned monies that are largely used to contribute to family income rather than to capital flows, and because migrants tend to be unfamiliar with investment instruments.(80) Existing research, however, underscores the fact that remittances could play a more significant role in development and poverty alleviation. Whether remittances are used for the purposes of investment or consumption, they bring important benefits to the households, communities and countries that receive them.(81) Remittances have proven more stable than other forms of private financial flows to developing countries and can cushion countries from economic fluctuations and shocks.(82) After an exhaustive analysis, the IOM concludes that recipients of international remittances are more likely to save, and that remittances can be used for small businesses and pave the way to credit for use as investment capital. By creating new demands for labour-intensive goods and services, they can also boost aggregate demand and, therefore, output and income. (83) The World Bank, the UN and other development institutions express similar views.(84)

What is missing, most experts agree, are mechanisms capable of harnessing the potential of remittances to promote longer-term economic growth. Another issue is the cost of transferring funds. While they have come down, transfer costs remain a key barrier owing to the fact that they can consume up to 20 per cent of remittance income.(85) Several institutions, including the World Bank, are already addressing this problem.(86)


Nowadays, improved communication and cheaper transportation mean that migration no longer represents a definitive break with the past. A large and growing number of links to the home community helps maintain local, national, ethnic and religious ties. In turn, such ties also help generate other kinds of financial flows beyond individual remittances—including FDI, expatriate tourism, hometown association philanthropy and fundraising.(87) Although the potential for development through formal diaspora networks is enormous, mechanisms for channelling it are still nascent.

Collective remittances could be combined with matching funds provided by public sources or by development agencies.(88) At present, the volume of "collective" remittances is still very small: In Central America, it represents only 1 per cent of total remittances.(89) In Mexico, government-sponsored programmes are attempting to channel worker remittances into infrastructure development and business start-ups. In 1999, Mexican federal, state and municipal governments started the "Tres por Uno" (Three for One) programme which provides three dollars for every one remittance dollar sent back from the US. In 2004, the programme successfully raised US$70 million that was then used to fund regional infrastructural and community projects. Programme organizers are now working with the World Bank to initiate projects that will lead to greater employment and thus encourage would-be émigrés to stay home.(90)

The transnational diaspora network can also form a bridgehead for home country enterprises looking to market goods and services to the host country.(91) For instance, many credit Korean-Americans with the successful penetration of the US market by Korean cars, electronics and manufactured products. In Canada, skilled migration from Asia led to a 74 per cent increase in Asian imports to the country. Meanwhile, formal and informal diaspora networks are playing a significant role transmitting information and knowledge to compatriots back home.(92) The importance of such networks is giving rise to policy recommendations aimed specifically at maximizing their developmental potential in a globalized society.

Further, there is the issue of "social" remittances–the transfer of ideas, information, knowledge, attitudes, behaviour patterns, identities, culture and social capital from one culture to another.(93) In their contacts with, or return to, communities of origin, migrants can become agents of political and cultural transformation, which can be particularly beneficial to furthering gender equality (see Chapter 2). Not only do source countries benefit, but receiving countries as well. In Australia, for example, the IOM contends that large-scale migration from Asia and elsewhere has greatly boosted the country's economic, social and political interactions with origin countries. Although the organization points out that such benefits have not yet been "quantified", they are nonetheless significant. These include linguistic and cultural diversity and a greater "openness" to other countries, in addition to a concomitant range of attitudes, values and mores. These have all contributed significantly to Australia’s culture and way of life.(94)

Burden or Boon?
Impact on Receiving Countries

Migration can bring both benefits and costs to receiving countries depending on cultural, social and economic context. The three most frequently voiced complaints related to economic concerns are: immigrants take jobs away from the local population; they drive down wages; and they are a heavy burden on the country's social welfare system. (95)

Empirical evidence to support each of these complaints is weak or ambiguous–at least at the aggregate level. The overall impact of migration on the employment and wages of the native population is modest, whether migrants are documented or undocumented, temporary or permanent.(96) This is because migrants tend to fill jobs that residents do not want. Migration inflows tend to affect low-skilled residents the most, who are more likely to directly compete with migrants who possess similar skills and educational background.(98) Added competition can keep wages down and may retard investment in more productive technologies. But many argue that the threat to employees working in blue-collar occupations is no worse than that caused by the introduction of cheap, labour-intensive imported goods. (97)

The common assumption that migrants rely heavily on public welfare but pay relatively little in taxes and welfare contributions also fails to hold up to empirical scrutiny in most cases.(99) A 2005 study, for example, found that, although immigrants account for 10.4 per cent of the US population, they consume only 7.9 per cent of the country's total health-care expenditure and 8 per cent of government health-care funds.(100) The US Central Intelligence Agency (CIA)(101) and, more recently, the European Commission (EC) maintain that migration contributes to overall growth, greater productivity and higher employment—for everyone.(102)

Beyond labour, wage and welfare issues, the demographic realities of ageing in developed countries have also put international migration in the spotlight. A year 2000 study undertaken by the UN Population Division on "replacement migration"(103) maintains that the majority of receiving countries are in what is known as the "the second demographic transition." This phase is characterized by low fertility and thus, by low or negative population growth, which then leads to a higher proportion of non-working elderly people compared to a younger, more productive population.(104) Many of the world’s more prosperous nations, particularly Japan and countries in Europe, are experiencing below-replacement fertility, reduced entry of young people into the labour market and, thus, accelerated demographic ageing.(105) Report authors calculate that slow-growing countries would need to acquire significantly more migrants in order to offset population decline and decreases in the working-age population, while also maintaining current ratios of workers to the over-65 population.(106)

Although it raised much-needed public awareness of the perils of population ageing, the publication sparked an uproar–both in political and academic circles.(107) Critics argue that migration is not necessarily a panacea for fertility decline because, from a demographic standpoint, it can only prevent the ageing of a country's population through unprecedented, unsustainable and increasing levels of inflow.(108) From a social standpoint, the volume of migration necessary to replace the declining population is beyond what any developed country would seriously consider.(109)

The controversy over "replacement migration" would appear to be, in part, a reflection of the strong emotions that multiculturalism and the prospect of massive immigration generates in many countries today. Most low-fertility countries have come to accept some immigration as economically useful, but are concerned with preserving cultural identity. Nevertheless, countries with ultra-low fertility such as Germany, Italy and Spain–and potentially several other countries—are facing a radical decline in population.(110)Dealing with it will require different approaches, within which migration could play an increasing, though not decisive, role.

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 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)


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 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)

Beyond Difference: Living with Diversity

A recent UN study shows that the proportion of countries that want to reduce international migration has declined, from 40 to 22 per cent between 1996 and 2005.(133)This is an encouraging sign. Despite numerous controversies, governments and communities are increasingly recognizing the value of international migration. Indeed, several recent analyses agree that, despite drawbacks, cross-border migration can result in substantial benefits—for migrants and for countries of origin and destination.(134)Since migration is, at least in principle, a necessity and a boon for both sides, why is it such a contentious issue? Why are so many nations increasingly focused on restricting immigration?

This is a sensitive issue. The real problem may lie less with the usually cited economic obstacles (most of which can be minimized with appropriate policies) than with social barriers, cultural and ethnic clashes and the growing spectre of escalating public hostility towards immigration in receiving countries.

In much of the 19th and 20th centuries, "assimilation" meant that migrants were often pressured to surrender their identity–that is, deposit their cultural baggage at the destination country door. In the US, for instance, immigrants–quite independently of their origin–were encouraged to become "Americanized" and were given assistance to do so.(135)In the latter part of the 20th century, however, this cultural steamroller approach became untenable, and policymakers began to embrace multiculturalism: the idea that all citizens adopt a common set values and ideals while, at the same time, maintaining their ethnicity and culturally distinctive beliefs in the private sphere.(136)

Ideally, as defined by Canada, "[M]ulticulturalism ensures that all citizens can keep their identities, can take pride in their ancestry and have a sense of belonging."(137)In practice, however, multiculturalism has been interpreted in many ways and has been applied in a variety of country contexts, with varying degrees of success and failure.(138)Many fear that mass migration is threatening the very concept of the nation-state. The notion of a national community based on ancestral lineage and cultural heritage is similarly being challenged. Moreover, practical difficulties in the implementation of multiculturalism–i.e., those related to the dominant language and culture in the host society—has prompted considerable backlash from both extreme right and mainstream commentators, especially in Europe.(139)On the other hand, the "ghettoization", or marginalization–socially, culturally, economically, politically and even spatially–of some migrant communities from mainstream society only serves to widen intercultural misunderstandings while, at the same time, thwarting integration.

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Regardless, the tensions witnessed in many immigrant-receiving countries are unquestionably real and are likely to increase as international migration inevitably expands under globalization. What can be done? The presence of sustained, participatory integration policies; representation of migrants' interests and rights by civil society organizations; and cooperation between source and destination countries are key factors determining integration outcomes. Approaches will inevitably vary. What may work in countries that were founded on immigration–such as Australia, Canada and the US–may not for nations characterized by common language, custom and culture that stretch back hundreds, if not thousands, of years. Moreover, some migrant communities are more open to integration than others–depending on religious, cultural and educational affiliation. In all situations, dispelling the myths that fuel discrimination and bolster xenophobia while promoting intercultural understanding is undoubtedly a step in the right direction. Whatever the specific approach, in a just society, we have to make it work.