The impact of migration is huge. There are a very high percentage of the population in the GCC countries are migrant. The health of migrant labor is important to study

1. Health of Immigrant Worker
Role of Family Physician
Professor Faisal Abdul Latif Alnasir FPC, FRCGP, MICGP, FFPH, PhD
Chairman; Dept. of Family & Community Medicine
Arabian Gulf University. Bahrain
President; Scientific Council Family & Com. Medicine
Arab Board for Medical Specializations
WONCA Representative
General Secretary; Int. Society for the History of Islamic Medicine
International Consultation on "Caring for All Working People: Interventions, Indicators and
Service Delivery", Semnan, Iran, from 28 to 30 April 2014

2. ‫إ‬‫هي‬ ‫الطب‬ ‫صناعة‬ ‫ن‬"‫العلوم‬ ‫أقدم‬ ‫بها‬ ‫والعلم‬ ‫الصنائع‬ ‫أشرف‬
‫الصنائع‬ ‫سائر‬ ‫على‬ ‫المرتبة‬ ‫في‬ ‫تتقدم‬ ‫أن‬ ‫ويجب‬‫والمهن‬"
(‫في‬‫الطبيب‬ ‫أدب‬)
(‫الرهاوي‬ ‫علي‬ ‫بن‬ ‫اسحق‬)
(‫الهجري‬ ‫الرابع‬ ‫القرن‬)
The industry of medicine is:
“the most honorable profession, which is
one of the oldest sciences and it must
advance any other trades and
professions”.
Ishaq Ali Alrahawi 4th Century H
Faisal Alnasir 2014 2

3. Content:
•Percentage of migrants worldwide
•The situation in ME and Gulf
•Factors affecting their health
•Health risks
•Effective measures
•Role of Family Physicians
Faisal Alnasir 2014 3

4. Three percent of the global population move
outside their country of birth, often for economic
reasons
Stilwell et al 2004
Faisal Alnasir 2014 4

5. World wide mobility increasing continuously.
Became more than double over the past
four decades, increasing from 82 million in
1970 to 200 million in 2005.
GCIM. 2005
0
50
100
150
200
250
1970 2005
No of Migrants In Millions
Faisal Alnasir 2014 5

6. Every year an estimated 105 million people
travel abroad to work
United Nation for human rights
Faisal Alnasir 2014 6

7. Approximately one-third of all migrants live in only
seven developed countries.
GCIM. 2005
Faisal Alnasir 2014 7
0
10
20
30
40
50
60
Number of migrants world wide
in millions
Pratik et all 2011

8. http://www.dailykos.com/story/2011
0%
20%
40%
60%
80%
100%
120%
Percentage of migrant workers in various nations
Faisal Alnasir 2014 8

9. http://www.dailykos.com/story/2011/
Faisal Alnasir 2014 9
1
3
2
4

10. More than ten million Filipinos have left to
seek jobs abroad because of high
unemployment level.
Every day, about 3,000 leave the country.
The majority go to Arab countries (200,000
in Saudi Arabia alone).
http://www.asianews.it/news-en/Christian-Filipino-migrants
Faisal Alnasir 2014 10

11. 0
5
10
15
20
25
USA Russia Germany India
Pratik et al 2011
Faisal Alnasir 2014 11
Migration of Nepalese Worker in 2000

12. Women:
• Half of the total population of international
migrants worldwide are women.
• 83% of all domestic workers (53 million) in
the world are women.
www.ilo.org/migrant
Faisal Alnasir 2014 12

13. Women Employment in EU
Faisal Alnasir 2014 13

14. Faisal Alnasir 2014 14
Iran
Hosts one of the world’s largest refugee
populations. Afghan refuge since the
Afghanistan’s conflict in 1970s. However Afghans
have a tradition of travelling to Iran.
More than three million Afghans in Iran of
whom only 3% are accommodated in refugee
camps.
They work as manual labor in agriculture,
construction, brick-making, stone-cutting, etc.
Bruce Koeoke, February 4, 2011

15. Faisal Alnasir 2014 15
Iran
Iran must be commended for managing this
responsibility largely independently and with
minimal international financial support for the
last three decades.
While consistently cooperating with UNHCR, the
Iranian government has preferred to manage its
refugee population by itself with some
government-approved NGOs.
Bruce Koeoke, February 4, 2011

16. Faisal Alnasir 2014 16

17. 0
10
20
30
40
50
60
70
80
90
Nationals
Expatriates
Structure of the GCC Population in 2004
Source: Publication of the government agencies of the GCC 2004
Faisal Alnasir 2014 17

18. In 2004, 7 out of ten of the workforce in the Gulf
States were foreigners.
90% of the Qatar and UAE workforce are
foreigners.
UN,2006
0
1
2
3
4
5
6
7
8
Foreign Local
Workers
Faisal Alnasir 2014 18

19. Faisal Alnasir 2014 19

20. The working population in the UAE
consists of:
•1.75 million Indians
•1.25 million Pakistanis
•500,000 Bangladeshis
•1 million other Asian
•500,000 European and African.
World Migration Report. 2010
Faisal Alnasir 2014 20

21. Host countries often perceive migrants as
exploitable, cheap and flexible labor and employ
them in
3-D jobs - Dirty, Dangerous and Degrading
Underpaid and without workplace safety and health
protections.
ILO,2009
And are seen as a burden on society, when in fact
their contribution to their host economy is often
underestimated.
Kawon et al 2011
Faisal Alnasir 2014 21

22. Problems
Of health issues
Issues contributing to the health disparities of
immigrants
Migrant workers face greater health risks than
non-migrant workers
Faisal Alnasir 2014 22

23. Migrants can face serious health
problems due to discrimination, language
and cultural barriers, their legal position,
and their low socio-economic status.
WHO 2003
Faisal Alnasir 2014 23

24. -Health issues impacting migrant workers are
complex and numerous.
-Migrant workers could have diseases that are
related to their nationalities.
e.g. in the UAE level of obesity is high among
certain nationalities of migrant workers while
the presence of hepatitis C antibodies was
found almost exclusive to Egyptian workers.
Newson-Smith MS 2010
Faisal Alnasir 2014 24

25. Immigrants may not follow preventive care and
treatment regimens.
Dastjerdi M,2012
-Cultural differences in health care seeking patterns
and the differences in the perception of health care
services. Culture shapes an individual's perception of
health, illness, and compliance with diagnosis and
treatment regimens.
National Institute of Health,2002
-Fear of disclosure. Not comfortable talking about their
issues out of fear of being expelled from employment
So they tend to tolerate harsh working and living
conditions longer than others.
Dastjerdi M,2012
Faisal Alnasir 2014 25

26. A study of lifestyle of Nepalese migrants in UK
found that migrants with low levels of
education and poor immigration status (e.g.
refugee/asylum seeker) are more likely to lack
good dental hygiene and regular exercise.
Adhikar et al, 2008
Faisal Alnasir 2014 26

27. -Adjusting; Migrant workers face difficulties in
adjusting to their new society including
adopting safe and healthy lifestyles.
-Female migrant workers are at a high risk of
physical, sexual and verbal abuse.
Arnold F, Shah N,1984; Gurung G, Adhikari J. 2001
Faisal Alnasir 2014 27

28. -Coming from developing countries with poor
health systems where communicable
diseases are not adequately addressed
-Employed in industries that involve
dangerous, dirty, and degrading work
-Language barriers
-lack access to local health systems.
BSR – Migration Linkages 2012
Faisal Alnasir 2014 28

29. -Lack of knowledge of the system
-At higher risk hazards that put immigrant
and minority workers in situation of
vulnerability.
Cote D 2013
Faisal Alnasir 2014 29

30. The Nepalese government revealed 70 nationals had
died on building sites in Qatar since the beginning of
2012. Hundreds more are thought to have been injured
in falls and accidents with machinery and vehicles.
International Trade Union Confederation (ITUC)
Faisal Alnasir 2014 30
Asian migrant construction workers face higher risk of
occupational accidents compared with the general
population
Al-Arrayed A, Hamza A. 1995

31. Faisal Alnasir 2014 31

32. One of the major risk to health is the
accommodation. Usually they live in an
overcrowded unhealthy condition that lacks
sanitation and be an environment for
deterioration of physical and mental health.
Faisal Alnasir 2014 32

33. Human Rights Watch: indicated that
overcrowded and unhygienic living
arrangements of migrants, correlated
with spread of disease. (referring to the outbreak
of chickenpox in a Sharjah labor camp in 2008).
Pernice R, Brook J. 1996
Faisal Alnasir 2014 33

34. Mental Problems: Immigrants from poorer
countries are at higher risk of mental illness
due to their living and working conditions.
Hence there is increase suicidal rate among
them. Pratik et al 2011
Faisal Alnasir 2014 34

35. Source: Migrant workers and health- the role of business
Faisal Alnasir 2014 35

36. It is legal obligation of countries of
destination, origin and transit to protect
the human rights of migrants on their
territory.
International Trade Union Confederation (ITUC)
Faisal Alnasir 2014 36

37. When tailoring interventions to vulnerable
populations, we should take into
consideration the importance of diverse
cultural beliefs and practices
Poureslami et al 2011
Faisal Alnasir 2014 37

38. To attain equitable, adequate, and
effective access to health care services,
immigrants need to be educated and
informed about the health care system
and services it provides. The more
immigrants become integrated the more
they use health care services effectively.
Dastjerdi M,2012
Faisal Alnasir 2014 38

39. ILO Meeting of Experts on Workers' Health
Surveillance, in 1997 in Geneva set guidelines
for occupational safety and health of workers
with the purpose of primary prevention of
occupational and work-related diseases and
injuries. It were considered to be the basic
requirements for the surveillance of workers'
health, and are not intended to discourage
competent authorities from adopting higher
standards.
www.ilo.org/safework 1998
Faisal Alnasir 2014 39

40. Executive Council of GCC Health Ministers
has recommended screening program for
foreign worker to prevent the entry of
infected employment. It includes
epidemiological, psychological, neurological
and sexual examinations besides other
tests to ensure that these workers do not
carry diseases.
www.alraimedia.com/alrai/Article.aspx?id=474801&date=03112013
Faisal Alnasir 2014 40

41. Faisal Alnasir 2014 41
WONCA Special Interest Group
Migrant Care, International Health and Travel Medicine
At the WONCA Executive meeting in Cebu, the Philippines,
in 2011 the expansion of the WONCA Special Interest Group
(SIG) on Travel Medicine was endorsed. The group will now
be known as the SIG on Migrant Care, International Health
and Travel Medicine. Our vision is for good access and
quality of primary care for all – temporally or permanently -
displaced people and travelers at all places in the world.

42. Faisal Alnasir 2014 42

43. Faisal Alnasir 2014 43
Entrance to Family and
Community Medicine 2 months
•Internal Medicine 5 months
•Pediatrics 4 months
•Obstetrics and Gynecology 3 months
• Surgery in all specialties
including Orthopedic Surgery 3 months
•Ophthalmic Diseases 2 months
•ENT Diseases 2 months
•Dermatologic Diseases 2 months
•Psychiatric Diseases 2 months
•Emergency Medicine 2 months
•Radiology and Laboratory
(diagnose procedures) 1 month
•Community Medicine 2 months
• Family Medicine (continuously in
the training center) 9 months
• Optional programs and selected
subjects in primary care 5 months
•Annual vacations
4 months in total one month for
each year
Overall training time duration 48 months
Arab Board Family Medicine Training program

44. Steps to protect the health of migrant workers
• Mapping and identifying health risks
• Building health profiles for migrant workers
• Developing preventative health programs
• Ensuring occupational health and safety
standards
• Taking proactive steps to ensure the
availability, accessibility, and acceptability of
health services in the destination
BSR – Migration Linkages 2012
Faisal Alnasir 2014 44

45. Faisal Alnasir 2014 45
It is our moral obligation to protect
people who helped us to change from

46. Thank You
Faisal Alnasir 2014 46