Cause of death of Sri Lankan migrant workers employed in the Middle EastBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7573.861-a (Published 19 October 2006) Cite this as: BMJ 2006;333:861
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Large numbers of migrant workers from South Asia and some East Asian
countries work in the Gulf Arab countries and richer states in the region
(1, 2). Even a small country like Sri Lanka exports more than a million
migrant workers. A large proportion of them are women (2). They provide a
major financial contribution to the economies of their home country by way
of regular foreign currency remittances.
Despite their major contributions to global productivity and economic
well-being, we seem to have allowed the health needs of this large segment
of society to be poorly catered for. Little research is done in this area.
A Medline literature search found less than 10 reports on health issues
among Asian migrant workers (3, 4). This is especially worrying because
the health needs and spectrum of diseases of migrant workers often differ
from routine care available in most importing countries.
Most workers are tested for a range of conditions and sometimes given
a number of vaccines as a pre-requisite for selection. This is often done
with little information, counselling or explanation provided. Often their
access to medical care is quite limited in the host country. Furthermore,
the migrant worker has little financial hope of joining private Health
care schemes that operate in some countries. Thus if they should fall
sick, they risk losing their job and been sent back to their home country
for treatment with little compensation violating the concept of social
security. Possible occupational hazards or health and safety issues at
work are poorly addressed. Some workers have their travel documents held
centrally by the employing agency making them bonded labourers, and
preventing workers from leaving their job even if they are unhappy and
depressed. Family separation (in many cases involving very young children
left at home) and cultural alienation adds to psychological issues faced
by some workers.
Female workers may be vulnerable in terms of physical and sexual
violence, psychological abuse, under nourishment and extreme exhaustion
(2). Local laws of some countries like Saudi Arabia, which make it
difficult for victims of sexual assault to report abuse and seek
assistance, compound this. Under Saudi Law, it is illegal to have sexual
relations outside of marriage. Furthermore, the Saudi Ministry of Health
issued a directive in 2003 that prohibited hospitals from admitting
pregnant women who were not accompanied by men willing to acknowledge
In 1990, the United Nations adopted the International Convention on
the protection of the rights of all migrant workers and members of their
families (5). However mechanisms in place for its proper implementation
are generally inadequate (2). Thus it was encouraging that officials from
20 migrant worker importing and exporting counties recently met in Abu
Dhabi to discuss aspects of regulation of the Asian migrant worker market.
Adequate provision of health care should now be a logical next step to be
actively promoted. In several developed countries specialist Travel Health
departments are in place. Similar models could be used in setting up
programmes to look after the health needs of the millions of Asian migrant
Promoting good health among Asian migrant workers should be high on
the agenda of Health Associations in both exporting and importing
countries and should also be taken up by International Heath forums. It is
our duty to act as advocates for better health care of individuals
providing significant economic benefit to many countries.
1. Varma UK, Sasikumar SK. External Migration and Remittances:
Trends, Policies, Impact and Development Potential. The Indian Case”, in
Labour Migration in Asia: Protection of Migrant Workers, Support Services
and Enhancing Development Benefits. IOM, Geneva, 2005.
2. Women Migrant Workers of Sri Lanka, CENWOR, Colombo, 2001.
3. Samarakkody DM, Jayawardana P, Abeysena C: Cause of death of Sri
Lankan migrant workers employed in the Middle East. Bmj 2006, 333:861.
4. Wilson D. Meeting the health needs of migrant workers affected by
the tsunami. PLoS Med 2005, 2:e176.
5. International Convention on the Protection of the Rights of all
Migrant Workers and Members of Their Families (ICRMW), General Assembly
Resolution 45/158 of 18 December 1990,
Suranjith L Seneviratne#, Pankaj Garg*
#St Mary’s Hospital and Imperial College, London, UK;
*Department of Paediatrics and Clinical Epidemiology, Sitaram Bhartia
Institute of Science and Research, New Delhi, India
Competing interests: No competing interests