Migrant health: a new series for The BMJ

The world is on the move

For some, migration is driven by conflict, for others environmental, social, or economic factors - but it all brings the promise of security or prosperity. However these journeys expose people to a wide range of problems - injury or infectious disease in transit, or leaving behind their health insurance.

In transit

In 2017, there were around 258 million international migrants*. Many of these come from more populous parts of the world such as Asia. They travel along established routes, both legal (regular) and undocumented (irregular).

* UN data -ref pls-

Migration is not a new phenomenon. However, the numbers of international migrants have been slowly rising. Since the year 2000, the number of migrants traveling to each of the 6 continents in this graphic each year has risen by between 2 and 3 percent.

A distorting lens

If you only read popular media, you’d be forgiven for thinking that the levels of migration are causing a “crisis” - that hoards of migrants are flooding into countries, overburdening their health systems and using up their public services. This has become key rhetoric in right-wing populist movements.

Seeking refuge

Popular media reports also tend to focus on refugees or asylum seekers (migrants whose claim to refugee status has not yet been evaluated). In 2018, there were about 23 million such forced migrants, according to UN estimates.

However, refugees and asylum seekers only make up about 10 percent of all international migrants. Additionally, 4 out of every 5 of them are hosted by developing countries.

The majority of international migrants are economic migrants, moving to work in another country where workers are needed - this mainly happens through formal employment pathways.

Remittance as development funding

Migrant workers not only contribute to economic growth and development in countries where they work, but send money home to benefit their families and communities. Migrants sent home more than $400 billion to their families in low and middle income countries in 2015. This is more than 3 times the foreign aid received.

Unofficial aid

Migrants sent home more than $400 billion to their families in low and middle income countries in 2015. This is more than 3 times the foreign aid received.

A mixed picture

There is great variability between countries in terms of migrants’ rights to healthcare. They may be excluded from accessing primary health care services, vaccination and health promotion interventions for several reasons, such as:

lack of legal status
stigma
discrimination
language
cultural barriers
low income levels

Case study 1: Shamila's story

A protracted drought in Sri Lanka led to underemployment for Shamila’s husband. To help provide for their two young children, she decided to travel to Qatar to work as a domestic maid, which she organised through an agency. The work was hard, but the money she managed to send home improved the health of her children, allowing access to more nutritious food and medicine. However, when Shamila became ill, her employment agency refused to help her to get medical assistance, claiming it was not their responsibility...

Case study 2: Muddaser’s story

Muddaser paid $5400 up front to an agent in his home country of Bangladesh, to secure construction work in Singapore. He worked every day with overtime, and managed to earn $1500 per month. While working, he was accidentally struck by moving heavy equipment. He recovered for 10 days in hospital, and received a right decompressive craniectomy, with his construction company paying the bill for over SGD 30 000. However, after returning to work, he was locked in a room and his documents were withheld, as the company tried to avoid paying further costs needed for a subsequent cranioplasty...

Case study 3: Thida’s story

Some migrants have a much smoother experience. Thida left her two children and their cousins with her mother in Cambodia, and travelled to Thailand to work in a poultry farm. Despite being an undocumented migrant worker, Thida was able to register with a Thai government health insurance scheme that provides comprehensive emergency and curative care. This means she can access the metformin medication she needs to manage her type 2 diabetes. From the money Thida remits home, her mother has been able to afford and introduce a greater variety of meat proteins to the diet of the children in the household.

Photo: Muse Mohammed / IOM

Knowledge gaps

If there is a true migrant crisis, it is the lack of effective migration management practices, poorly formulated migration policies and health policies at national, regional and global levels. Part of the problem is the lack of an evidence base to inform policy and practice. Despite migrant workers comprising 60% of all international migrants, they were included in only 6% of published research on migration health over the last 20 years. Little is known about different migrant types, their health status, health issues, health coverage and how they navigate health care.

The BMJ Migration health series

The BMJ’s migration health series aims to provide insights and perspectives by researchers, policy makers, practitioners, civil society, and migrants themselves on issues, challenges and complexities in advancing migration health at national, regional and global levels. It is developed in collaboration with the UN’s Migration agency (IOM) and the Migration Health and Development Research Network (MHADRI) – a global network of migration health researchers.

Papers for the series are policy perspectives and analytical pieces of up to 2,000 words in length. The BMJ encourages submissions from a diverse range of stakeholders. Perspectives from countries in the global south, and papers written collaboratively between researchers and policy makers are encouraged.